MEDICARE: MEDICAL SUPPLY COMPANY OF ILLINOIS LLC

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	332BN1400X	Nursing Facility Supplies (DME)	28771362	IL

General Provider Information

NPI Number	:	1235251059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL SUPPLY COMPANY OF ILLINOIS LLC

Provider Business Mailing Address
First Line	:	5061 N PULASKI RD
Second Line	:	SUITE 204
City	:	CHICAGO
State	:	IL
Zip	:	60630-2706
Country	:	US
Telephone Number	:	773-487-1186
Fax Number	:	773-478-1192

Provider Business Practice Location Address
First Line	:	5061 N PULASKI RD
Second Line	:	SUITE 204
City	:	CHICAGO
State	:	IL
Zip	:	60630-2706
Country	:	US
Telephone Number	:	773-487-1186
Fax Number	:	773-478-1192

Authorized Official
Title or Position	:	CFO
Name	:	MR. SHERMAN F DELLA
Credential	:	CPA
Telephone Number	:	773-509-0681

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	12/04/2007

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