Provider Demographics
NPI:1134264286
Name:BRIDGEMARK MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:BRIDGEMARK MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-994-2306
Mailing Address - Street 1:1140 LAKE ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1049
Mailing Address - Country:US
Mailing Address - Phone:312-994-2306
Mailing Address - Fax:
Practice Address - Street 1:1140 LAKE ST
Practice Address - Street 2:SUITE 410
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1049
Practice Address - Country:US
Practice Address - Phone:312-994-2306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment