MEDICARE: NATIONAL MEDICAL SUPPLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	4857510002	IL

General Provider Information

NPI Number	:	1053326595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	8646 S ROBERTS RD
Second Line	:
City	:	JUSTICE
State	:	IL
Zip	:	60458-2309
Country	:	US
Telephone Number	:	708-599-2220
Fax Number	:	708-599-2221

Provider Business Practice Location Address
First Line	:	8646 S ROBERTS RD
Second Line	:
City	:	JUSTICE
State	:	IL
Zip	:	60458-2309
Country	:	US
Telephone Number	:	708-599-2220
Fax Number	:	708-599-2221

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ADA UJU
Credential	:
Telephone Number	:	708-599-2220

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	04/29/2008

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