Provider Demographics
NPI:1700198991
Name:GROUND UP MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:GROUND UP MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-629-6700
Mailing Address - Street 1:10918 S WESTERN AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3200
Mailing Address - Country:US
Mailing Address - Phone:773-629-6700
Mailing Address - Fax:773-881-3116
Practice Address - Street 1:10918 S WESTERN AVE STE 8
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3200
Practice Address - Country:US
Practice Address - Phone:773-629-6700
Practice Address - Fax:773-881-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2042849332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies