MEDICARE: PACIFIC MEDICAL EQUIPMENT AND SUPPLIES 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001635323	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1376689612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC MEDICAL EQUIPMENT AND SUPPLIES INC

Provider Business Mailing Address
First Line	:	2140 W 95TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1019
Country	:	US
Telephone Number	:	773-238-3440
Fax Number	:	773-238-3450

Provider Business Practice Location Address
First Line	:	2140 W 95TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1019
Country	:	US
Telephone Number	:	773-238-3440
Fax Number	:	773-238-3450

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	SAMUEL E OKORO
Credential	:
Telephone Number	:	773-238-3440

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/10/2011

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