MEDICARE: OMEGA HOME MEDICAL EQUIPMENT & SUPPLIES 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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1922284140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMEGA HOME MEDICAL EQUIPMENT & SUPPLIES LLC

Provider Business Mailing Address
First Line	:	1717 HOWARD ST
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-3735
Country	:	US
Telephone Number	:	847-425-9089
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 HOWARD ST
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-3735
Country	:	US
Telephone Number	:	847-425-9089
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	EDWARD L OLLER JR.
Credential	:
Telephone Number	:	773-218-9566

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	01/17/2008

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