Healthcare Provider Details

I. General information

NPI: 1083855167
Provider Name (Legal Business Name): 1ST CHOICE MEDICAL SUPPLIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 LINCOLN HWY
OLYMPIA FIELDS IL
60461-1936
US

IV. Provider business mailing address

2555 LINCOLN HWY
OLYMPIA FIELDS IL
60461-1936
US

V. Phone/Fax

Practice location:
  • Phone: 708-748-9860
  • Fax: 708-887-0660
Mailing address:
  • Phone: 708-748-9860
  • Fax: 708-887-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. EMIL TOBEY LIPSCOMB
Title or Position: PRESIDENT
Credential:
Phone: 708-712-4863