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General NPI Number Information
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NPI Number | 1992290647
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Entity Type | Organization
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Legal Business Name | PACK MACHINE INCORPORATED
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 307 W SAINT PAUL ST
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City | SPRING VALLEY
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State | IL
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Zip | 61362-1860
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Country | US
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Telephone | 312-315-6584
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Fax |
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Provider Business Mailing Address
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Address Line | 307 W SAINT PAUL ST
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City | SPRING VALLEY
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State | IL
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Zip | 61362-1860
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Country | US
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Telephone | 312-315-6584
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDGAR ALEXANDER BARRIOS
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Credential | PEDORTHIST
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Telephone | 312-315-6584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 212000132
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License Number State | IL
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