Healthcare Provider Details

I. General information

NPI: 1376827931
Provider Name (Legal Business Name): WINDY CITY MEDICAL SUPPLY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 ASHLAND AVE SUITE B
CHICAGO HEIGHTS IL
60411-1639
US

IV. Provider business mailing address

529 ASHLAND AVE SUITE B
CHICAGO HEIGHTS IL
60411-1639
US

V. Phone/Fax

Practice location:
  • Phone: 708-585-0530
  • Fax:
Mailing address:
  • Phone: 708-585-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN AKPAN
Title or Position: PRESIDENT
Credential:
Phone: 708-585-0530