Provider Demographics
NPI:1922284140
Name:OMEGA HOME MEDICAL EQUIPMENT & SUPPLIES LLC
Entity Type:Organization
Organization Name:OMEGA HOME MEDICAL EQUIPMENT & SUPPLIES LLC
Other - Org Name:SUMMIT HOME MEDICAL EQUIPMENT & SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:773-218-9566
Mailing Address - Street 1:1717 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3735
Mailing Address - Country:US
Mailing Address - Phone:847-425-9089
Mailing Address - Fax:
Practice Address - Street 1:1717 HOWARD ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3735
Practice Address - Country:US
Practice Address - Phone:847-425-9089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies