MEDICARE: HOME MEDICAL 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	203000119	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	09923225	OTHER	IL	BCBS OF IL

General Provider Information

NPI Number	:	1669553517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME MEDICAL SUPPLIES INC

Provider Business Mailing Address
First Line	:	422 SOUTH GOVERNORS HIGHWAY
Second Line	:
City	:	PEOTONE
State	:	IL
Zip	:	60468-9113
Country	:	US
Telephone Number	:	708-259-9880
Fax Number	:	708-258-9888

Provider Business Practice Location Address
First Line	:	422 SOUTH GOVERNORS HIGHWAY
Second Line	:	SUITE 15
City	:	PEOTONE
State	:	IL
Zip	:	60468-9113
Country	:	US
Telephone Number	:	708-259-9880
Fax Number	:	708-258-9888

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	MRS. JODI LYNN WOLFF
Credential	:
Telephone Number	:	708-258-9880

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	10/08/2008

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