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General NPI Number Information
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NPI Number | 1922810308
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE RESOURCES, INC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 12333 S 70TH AVE
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1508
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Country | US
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Telephone | 312-450-5592
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Fax |
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Provider Business Mailing Address
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Address Line | 15941 HARLEM AVE STE 194
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City | TINLEY PARK
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State | IL
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Zip | 60477-1609
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Country | US
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Telephone | 312-450-5592
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Fax | 708-847-0418
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOEL VANDER WEELE
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Credential |
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Telephone | 630-988-3451
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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 |
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