Provider Demographics
NPI:1760411508
Name:RUBY AMERICA, INC.
Entity Type:Organization
Organization Name:RUBY AMERICA, INC.
Other - Org Name:LAKES MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:V
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-623-9529
Mailing Address - Street 1:3900 WASHINGTON ST
Mailing Address - Street 2:SUITE V
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5717
Mailing Address - Country:US
Mailing Address - Phone:847-623-9529
Mailing Address - Fax:847-623-9530
Practice Address - Street 1:3900 WASHINGTON ST
Practice Address - Street 2:SUITE V
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5717
Practice Address - Country:US
Practice Address - Phone:847-623-9529
Practice Address - Fax:847-623-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5697680001Medicare ID - Type UnspecifiedDME/HME