Organization
ACTIVE MEDICAL SUPPLY CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY ANNE HENEGHAN (PRESIDENT)
(708) 878-3736
Entity
Organization
Contact information
Practice address
8434 CORCORAN RD, WILLOW SPRINGS, IL 60480-1666
(708) 878-3736
Mailing address
8434 CORCORAN RD, WILLOW SPRINGS, IL 60480-1666
(708) 878-3736
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
IL
Other
Enumeration date
12/04/2009
Last updated
12/04/2009
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