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General NPI Number Information
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NPI Number | 1376985929
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Entity Type | Organization
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Legal Business Name | MELROSE MEDICAL SUPPLY COMPANY, LLC
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | 1811 N 19TH AVE
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City | MELROSE PARK
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State | IL
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Zip | 60160-2025
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Country | US
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Telephone | 312-860-3273
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 WALTON ST
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City | MELROSE PARK
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State | IL
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Zip | 60160-3433
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Country | US
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Telephone | 312-860-3273
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. BETH ANN SWETLAND-PILATI
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Credential | O.D.
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Telephone | 312-860-3273
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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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