Healthcare Provider Details

I. General information

NPI: 1265427033
Provider Name (Legal Business Name): NORTHERN ILLINOIS HOME MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 RIVER RD
STERLING IL
61081-4150
US

IV. Provider business mailing address

3312 RIVER RD
STERLING IL
61081-4150
US

V. Phone/Fax

Practice location:
  • Phone: 815-626-4041
  • Fax: 815-626-6212
Mailing address:
  • Phone: 815-626-4041
  • Fax: 815-626-6212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203000341
License Number StateIL

VIII. Authorized Official

Name: MRS. MELISSA SHEPPARD-MILLER
Title or Position: PRESIDENT
Credential:
Phone: 815-626-4041