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General NPI Number Information
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NPI Number | 1538305198
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Entity Type | Organization
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Legal Business Name | KCAMLAED MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 12/31/2008
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Last Update Date | 12/29/2009
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Provider Practice Location Address
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Address Line | 16900 LATHROP AVE
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City | HARVEY
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State | IL
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Zip | 60426-6033
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Country | US
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Telephone | 708-596-5671
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Fax | 708-596-5623
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Provider Business Mailing Address
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Address Line | 15341 4TH AVE
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City | PHOENIX
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State | IL
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Zip | 60426-2620
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Country | US
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Telephone | 708-333-2498
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. SAMUEL C MACK
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Credential |
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Telephone | 708-333-2498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #5
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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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