Provider Demographics
NPI:1295725059
Name:ROSS MEDICAL SUPPLY CO INC
Entity type:Organization
Organization Name:ROSS MEDICAL SUPPLY CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-797-9099
Mailing Address - Street 1:4871 41ST ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7582
Mailing Address - Country:US
Mailing Address - Phone:309-797-9099
Mailing Address - Fax:
Practice Address - Street 1:4871 41ST ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7582
Practice Address - Country:US
Practice Address - Phone:309-797-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0951806OtherPUBLIC AID
IA0951806OtherPUBLIC AID
IA0951806OtherPUBLIC AID
IL=========001Medicaid