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General NPI Number Information
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NPI Number | 1265979389
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Entity Type | Organization
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Legal Business Name | 1 STOP MEDICAL SUPPLY SHOP
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 1055 W BRYN MAWR AVE STE F252
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City | CHICAGO
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State | IL
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Zip | 60660-4691
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Country | US
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Telephone | 773-892-5051
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Fax | 855-839-7078
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Provider Business Mailing Address
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Address Line | 1055 W BRYN MAWR AVE STE F252
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City | CHICAGO
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State | IL
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Zip | 60660-4691
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Country | US
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Telephone | 773-892-5051
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Fax | 855-839-7078
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY BANKS
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Credential |
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Telephone | 773-892-5051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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