Provider Demographics
NPI:1801225354
Name:MEDLINE INDUSTRIES, LP
Entity Type:Organization
Organization Name:MEDLINE INDUSTRIES, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP HOMECARE AND MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:POCKLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-931-1230
Mailing Address - Street 1:3 LAKES DR
Mailing Address - Street 2:
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 1:5701 PROMONTORY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-9201
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:2013-11-05
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1300000653332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0428930007Medicare NSC