MEDICARE: MARS MEDICAL EQUIPMENT & 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	203000219	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21623109	OTHER	IL	BLUE CROSS NUMBER

General Provider Information

NPI Number	:	1730185257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARS MEDICAL EQUIPMENT & SUPPLY, INC.

Provider Business Mailing Address
First Line	:	333 W MAPLE ST
Second Line	:	UNIT 2
City	:	NEW LENOX
State	:	IL
Zip	:	60451-1633
Country	:	US
Telephone Number	:	708-425-1550
Fax Number	:	815-462-9358

Provider Business Practice Location Address
First Line	:	333 W MAPLE ST
Second Line	:	UNIT 2
City	:	NEW LENOX
State	:	IL
Zip	:	60451-1633
Country	:	US
Telephone Number	:	708-425-1550
Fax Number	:	815-462-9358

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL J MAROLDA
Credential	:
Telephone Number	:	708-425-1550

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/16/2008

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