Provider Demographics
NPI:1760801963
Name:MEDLINE INDUSTRIES, LP
Entity Type:Organization
Organization Name:MEDLINE INDUSTRIES, LP
Other - Org Name:MEDLINE INDUSTRIES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SVP HOMECARE AND MANAGED CARE
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:C
Authorized Official - Last Name:POCKLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-265-6512
Mailing Address - Street 1:3 LAKES DR.
Mailing Address - Street 2:ATTN: HOMECARE COMPLIANCE
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2753
Mailing Address - Country:US
Mailing Address - Phone:844-265-6512
Mailing Address - Fax:866-779-5827
Practice Address - Street 1:1 MEDLINE DRIVE
Practice Address - Street 2:
Practice Address - City:WILMER
Practice Address - State:TX
Practice Address - Zip Code:75172-2107
Practice Address - Country:US
Practice Address - Phone:866-356-4997
Practice Address - Fax:866-202-1563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000243332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3587834-01Medicaid
0428930002Medicare NSC