Provider Demographics
NPI:1669409959
Name:COLONIAL MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:COLONIAL MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:I
Authorized Official - Last Name:NOTTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-247-4770
Mailing Address - Street 1:340 ASHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-2335
Mailing Address - Country:US
Mailing Address - Phone:847-247-4770
Mailing Address - Fax:
Practice Address - Street 1:340 ASHWOOD CT
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-2335
Practice Address - Country:US
Practice Address - Phone:847-247-4770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000369332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4411810001Medicare ID - Type UnspecifiedPROVIDER NUMBER
IL4411810001Medicare NSC