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Organization
PACK MACHINE INCORPORATED
Active
Organization
PACK MACHINE INCORPORATED
Active
Other names
N/A
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDGAR ALEXANDER BARRIOS PEDORTHIST (PRESIDENT)
(312) 315-6584
Entity
Organization
Contact information
Practice address
307 W SAINT PAUL ST, SPRING VALLEY, IL 61362-1860
(312) 315-6584
Mailing address
307 W SAINT PAUL ST, SPRING VALLEY, IL 61362-1860
(312) 315-6584
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
212000132
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
212000132
ILLINOIS LICENSE
IL
Enumeration date
06/26/2018
Last updated
06/26/2018
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