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General NPI Number Information
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NPI Number | 1427072180
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Entity Type | Organization
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Legal Business Name | COUNTRY MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1501 W DUNDEE RD SUITE 107
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-4006
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Country | US
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Telephone | 847-454-1300
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Fax | 847-454-1301
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Provider Business Mailing Address
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Address Line | 1501 W DUNDEE RD SUITE 107
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-4006
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Country | US
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Telephone | 847-454-1300
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Fax | 847-454-1301
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Authorized Official
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Title or Position | OWNER
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Name | MRS. IRINA MUCHNIK
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Credential |
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Telephone | 847-454-1300
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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 | IL
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