Provider Demographics
NPI:1265427033
Name:NORTHERN ILLINOIS HOME MEDICAL SUPPLY
Entity type:Organization
Organization Name:NORTHERN ILLINOIS HOME MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPARD-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-626-4041
Mailing Address - Street 1:3312 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-4150
Mailing Address - Country:US
Mailing Address - Phone:815-626-4041
Mailing Address - Fax:815-626-6212
Practice Address - Street 1:3312 RIVER RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-4150
Practice Address - Country:US
Practice Address - Phone:815-626-4041
Practice Address - Fax:815-626-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000341332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09832001OtherBLUE CROSS BLUE SHIELD
072724OtherHEALTH ALLIANCE MED PLANS
IL=========001Medicaid
IL4361270001Medicare NSC