MEDICARE: ARMOR MEDICAL SUPPLY CHICAGO WEST

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	:	1922329168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARMOR MEDICAL SUPPLY CHICAGO WEST

Provider Business Mailing Address
First Line	:	2923 W JACKSON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3635
Country	:	US
Telephone Number	:	708-557-5074
Fax Number	:	815-469-2398

Provider Business Practice Location Address
First Line	:	2923 W JACKSON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3635
Country	:	US
Telephone Number	:	708-557-5074
Fax Number	:	815-469-2398

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. KIMBREL DWANE STEPHEN
Credential	:
Telephone Number	:	708-557-5074

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	06/22/2010

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