MEDICARE: VAN DRIELS MEDICAL SUPPORT WEAR CO

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

General Provider Information

NPI Number	:	1174531685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAN DRIELS MEDICAL SUPPORT WEAR CO

Provider Business Mailing Address
First Line	:	720 E NORTHWEST HWY
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-3442
Country	:	US
Telephone Number	:	847-253-6494
Fax Number	:	847-253-1028

Provider Business Practice Location Address
First Line	:	720 E NORTHWEST HWY
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-3442
Country	:	US
Telephone Number	:	847-253-6494
Fax Number	:	847-253-1028

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. CLAUDIA M BOYLE
Credential	:
Telephone Number	:	847-253-6494

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	01/23/2008

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