Organization
AMERICAN MEDICAL SUPPLY CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IBE NWOSU (PRESIDENT)
(773) 936-5211
Entity
Organization
Contact information
Practice address
456 E 75TH ST, CHICAGO, IL 60619-2229
(773) 371-0067
(773) 371-0097
Mailing address
456 E 75TH ST, CHICAGO, IL 60619-2229
(773) 371-0067
(773) 371-0097
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01635415
BLUE CROSS BLUE SHIELD
IL
Enumeration date
01/10/2007
Last updated
04/20/2008
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