MEDICARE: PRODIGY MEDICAL & HOSPITAL 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	001	IL

General Provider Information

NPI Number	:	1770601999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRODIGY MEDICAL & HOSPITAL SUPPLIES, INC.

Provider Business Mailing Address
First Line	:	430 WEST 14TH STREET (LINCOLN HIGHWAY)
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-2663
Country	:	US
Telephone Number	:	708-747-1900
Fax Number	:	708-747-8700

Provider Business Practice Location Address
First Line	:	430 WEST 14TH STREET (LINCOLN HIGHWAY)
Second Line	:
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-2663
Country	:	US
Telephone Number	:	708-747-1900
Fax Number	:	708-747-8700

Authorized Official
Title or Position	:	BUSSINESS MANAGER
Name	:	EKAETE G. OBONG
Credential	:
Telephone Number	:	708-747-1900

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/21/2022

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