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NPI Code Detail

MEDICARE: MIMI MEDICAL SUPPLY LLC

MEDICARE: MIMI MEDICAL SUPPLY LLC
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
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1356229942
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIMI MEDICAL SUPPLY LLC
Provider Business Mailing Address
First Line : 1905 W RIVERSIDE BLVD
Second Line :
City : ROCKFORD
State : IL
Zip : 61103-1502
Country : US
Telephone Number : 872-702-3523
Fax Number :
Provider Business Practice Location Address
First Line : 1905 W RIVERSIDE BLVD
Second Line :
City : ROCKFORD
State : IL
Zip : 61103-1502
Country : US
Telephone Number : 872-702-3523
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : HEATHER MARLOW
Credential :
Telephone Number : 872-702-3523
Provider Enumeration Date : 08/22/2025
Last Update Date : 11/03/2025

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Directions to “MIMI MEDICAL SUPPLY LLC ” Practice Location

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