MEDICARE: SIMPOL RESPIRATORY EQUIPMENT INC

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	203-000589	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1670178	OTHER	IL	BLUE CROSS BLUE SHIELD IL

General Provider Information

NPI Number	:	1396748968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPOL RESPIRATORY EQUIPMENT INC

Provider Business Mailing Address
First Line	:	3415 W. MADISON
Second Line	:	SIMPOL RESPIRATORY EQUIPMENT INC.
City	:	SKOKIE
State	:	IL
Zip	:	60076-2928
Country	:	US
Telephone Number	:	847-967-6767
Fax Number	:	847-450-1666

Provider Business Practice Location Address
First Line	:	3415 W. MADISON
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-2928
Country	:	US
Telephone Number	:	847-967-6767
Fax Number	:	847-967-6841

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PAUL MELEKSON
Credential	:
Telephone Number	:	847-967-6767

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	06/13/2012

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