Provider Demographics
NPI:1740306885
Name:QUAD COUNTY HOME MEDICAL SUPPLIES & EQUIPMENT
Entity type:Organization
Organization Name:QUAD COUNTY HOME MEDICAL SUPPLIES & EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-562-2131
Mailing Address - Street 1:8 HUBER ST
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-1721
Mailing Address - Country:US
Mailing Address - Phone:217-562-6362
Mailing Address - Fax:217-562-6395
Practice Address - Street 1:8 HUBER ST
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1721
Practice Address - Country:US
Practice Address - Phone:217-562-6362
Practice Address - Fax:217-562-6395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
203000103332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL=========002Medicaid