=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497061840
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLATINUM MEDICAL SUPPLIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2010
-----------------------------------------------------
Last Update Date | 08/24/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 452 PARK RIDGE LN UNIT H
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60504-6145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-336-1829
-----------------------------------------------------
Fax | 630-978-4524
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 452 PARK RIDGE LN UNIT H
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60504-6145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-336-1829
-----------------------------------------------------
Fax | 630-978-4524
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. JENNIFER TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-336-1829
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------