Healthcare Provider Details

I. General information

NPI: 1356508055
Provider Name (Legal Business Name): PROMED MEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10913 S LONGWOOD DR #1
CHICAGO IL
60643-3358
US

IV. Provider business mailing address

10913 S LONGWOOD DR #1
CHICAGO IL
60643-3358
US

V. Phone/Fax

Practice location:
  • Phone: 773-233-5254
  • Fax: 773-233-5254
Mailing address:
  • Phone: 773-233-5254
  • Fax: 773-233-5254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. WASIM SAID
Title or Position: PRESIDENT
Credential:
Phone: 773-233-5254