Healthcare Provider Details

I. General information

NPI: 1275307969
Provider Name (Legal Business Name): ANDERSON'S DURABLE MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4749 LINCOLN MALL DR STE 202B
MATTESON IL
60443-2348
US

IV. Provider business mailing address

14747 MONTGOMERY DR
ORLAND PARK IL
60462-3273
US

V. Phone/Fax

Practice location:
  • Phone: 708-546-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ARIES L THOMAS
Title or Position: OWNER
Credential:
Phone: 708-546-0000