Provider Demographics
NPI:1790844587
Name:S & S DURABLE MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:S & S DURABLE MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-298-9334
Mailing Address - Street 1:1832 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1104
Mailing Address - Country:US
Mailing Address - Phone:773-298-9334
Mailing Address - Fax:773-298-9336
Practice Address - Street 1:1832 W 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1104
Practice Address - Country:US
Practice Address - Phone:773-298-9334
Practice Address - Fax:773-298-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2022-07-21
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
IL1622105OtherBCBS
IL1622105OtherBCBS
IL1129840001Medicare ID - Type UnspecifiedPROVIDER NUMBER