MEDICARE: 1 STOP MEDICAL SUPPLY SHOP

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

General Provider Information

NPI Number	:	1265979389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1 STOP MEDICAL SUPPLY SHOP

Provider Business Mailing Address
First Line	:	1055 W BRYN MAWR AVE
Second Line	:	STE F252
City	:	CHICAGO
State	:	IL
Zip	:	60660-4691
Country	:	US
Telephone Number	:	773-892-5051
Fax Number	:	855-839-7078

Provider Business Practice Location Address
First Line	:	1055 W BRYN MAWR AVE
Second Line	:	STE F252
City	:	CHICAGO
State	:	IL
Zip	:	60660-4691
Country	:	US
Telephone Number	:	773-892-5051
Fax Number	:	855-839-7078

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY BANKS
Credential	:
Telephone Number	:	773-892-5051

Provider Enumeration Date	:	01/26/2017
Last Update Date	:	01/26/2017

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