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General NPI Number Information
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NPI Number | 1750635348
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Entity Type | Organization
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Legal Business Name | WEST LOOP MEDICAL EQUIPMENT AND SUPPLIES, INC.
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Dates
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Enumeration Date | 11/03/2012
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Last Update Date | 11/03/2012
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Provider Practice Location Address
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Address Line | 115 N DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-2481
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Country | US
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Telephone | 312-243-0583
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Fax | 312-243-3637
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Provider Business Mailing Address
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Address Line | 115 N DAMEN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-2481
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Country | US
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Telephone | 312-243-0583
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Fax | 312-243-3637
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERNEST EDWARD ELLISON
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Credential | P.A.
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Telephone | 312-243-0583
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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 | 203001516
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License Number State | IL
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