Provider Demographics
NPI:1245663160
Name:ORTHO PRO MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:ORTHO PRO MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/VICEPRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OREST
Authorized Official - Middle Name:
Authorized Official - Last Name:POROCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-818-5369
Mailing Address - Street 1:401 E PROSPECT AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3366
Mailing Address - Country:US
Mailing Address - Phone:773-818-5369
Mailing Address - Fax:
Practice Address - Street 1:401 E PROSPECT AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3366
Practice Address - Country:US
Practice Address - Phone:773-818-5369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment