=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619588571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MED SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2020
-----------------------------------------------------
Last Update Date | 08/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 HERITAGE DR STE 108
-----------------------------------------------------
City | BOURBONNAIS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60914-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-833-2797
-----------------------------------------------------
Fax | 815-283-4720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 HERITAGE DR STE 108
-----------------------------------------------------
City | BOURBONNAIS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60914-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-833-2797
-----------------------------------------------------
Fax | 815-283-4720
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MRS. RHONDA WHITERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-833-2797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------