Healthcare Provider Details

I. General information

NPI: 1487473039
Provider Name (Legal Business Name): FITZSIMMONS SURGICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 230
INDIANAPOLIS IN
46237-8760
US

IV. Provider business mailing address

PO BOX 1127
TINLEY PARK IL
60477-7927
US

V. Phone/Fax

Practice location:
  • Phone: 317-800-6955
  • Fax: 317-245-8079
Mailing address:
  • Phone: 708-532-1199
  • Fax: 708-532-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMAS FITZSIMMONS
Title or Position: PRESIDENT
Credential:
Phone: 708-532-1199