Healthcare Provider Details

I. General information

NPI: 1609474832
Provider Name (Legal Business Name): CSO DME-MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2020
Last Update Date: 10/10/2020
Certification Date: 10/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7543 183RD ST
TINLEY PARK IL
60477-6208
US

IV. Provider business mailing address

7543 183RD ST
TINLEY PARK IL
60477-6208
US

V. Phone/Fax

Practice location:
  • Phone: 708-263-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GREGORY PRIMUS
Title or Position: OWNER
Credential: MD
Phone: 780-263-2000