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General NPI Number Information
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NPI Number | 1205070810
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Entity Type | Organization
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Legal Business Name | MEDSTREAM CORPORATION
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Dates
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Enumeration Date | 04/27/2009
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 666 DUNDEE RD SUITE 807
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City | NORTHBROOK
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State | IL
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Zip | 60062-2727
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Country | US
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Telephone | 224-406-8997
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Fax | 224-406-8998
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Provider Business Mailing Address
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Address Line | 666 DUNDEE RD SUITE 807
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City | NORTHBROOK
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State | IL
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Zip | 60062-2727
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Country | US
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Telephone | 224-406-8997
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Fax | 224-406-8998
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JULIA R TROSMAN
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Credential | PHD
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Telephone | 225-619-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 203000513
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 332BD1200X
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Taxonomy Name | Dialysis Equipment & Supplies (DME)
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License Number | 203000513
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number | 203000513
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 203000513
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 203000513
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 203000513
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License Number State | IL
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