MEDICARE: FAMILY MEDICAL EQUIPMENT AND SUPPLY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	203-000372	IL

General Provider Information

NPI Number	:	1174526776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL EQUIPMENT AND SUPPLY INC

Provider Business Mailing Address
First Line	:	3641 N MEADOWBROOK RD
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-1214
Country	:	US
Telephone Number	:	309-682-1900
Fax Number	:	309-682-1619

Provider Business Practice Location Address
First Line	:	3641 N MEADOWBROOK RD
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61604-1214
Country	:	US
Telephone Number	:	309-682-1900
Fax Number	:	309-682-1619

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MRS. SUZANNE JOHN
Credential	:	RCP
Telephone Number	:	309-682-1900

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/13/2013

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