Provider Demographics
NPI:1942399753
Name:AMEGROW GROUP INC.
Entity Type:Organization
Organization Name:AMEGROW GROUP INC.
Other - Org Name:AMEGROW MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AYODELE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUNBIADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-451-0600
Mailing Address - Street 1:1400 W DEVON AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1312
Mailing Address - Country:US
Mailing Address - Phone:773-451-0600
Mailing Address - Fax:773-451-0606
Practice Address - Street 1:704 E 44TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3541
Practice Address - Country:US
Practice Address - Phone:773-451-0600
Practice Address - Fax:773-451-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6223-307-9343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid