Provider Demographics
NPI:1750635348
Name:WEST LOOP MEDICAL EQUIPMENT AND SUPPLIES, INC.
Entity Type:Organization
Organization Name:WEST LOOP MEDICAL EQUIPMENT AND SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:312-243-0583
Mailing Address - Street 1:115 N DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2481
Mailing Address - Country:US
Mailing Address - Phone:312-243-0583
Mailing Address - Fax:312-243-3637
Practice Address - Street 1:115 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2481
Practice Address - Country:US
Practice Address - Phone:312-243-0583
Practice Address - Fax:312-243-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203001516332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies