Provider Demographics
NPI:1457785990
Name:DIVINE MEDICAL EQUIPMENT SUPPLY COMPANY
Entity Type:Organization
Organization Name:DIVINE MEDICAL EQUIPMENT SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEBO
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLANIYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-321-8218
Mailing Address - Street 1:15475 S PARK AVE
Mailing Address - Street 2:110
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1328
Mailing Address - Country:US
Mailing Address - Phone:708-321-8218
Mailing Address - Fax:708-321-8219
Practice Address - Street 1:15475 S PARK AVE
Practice Address - Street 2:110
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1328
Practice Address - Country:US
Practice Address - Phone:708-321-8218
Practice Address - Fax:708-321-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies