Organization
MIMI MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER MARLOW (MANAGER)
(667) 284-7662
Entity
Organization
Contact information
Practice address
1905 W RIVERSIDE BLVD, ROCKFORD, IL 61103-1502
(872) 702-3523
Mailing address
1905 W RIVERSIDE BLVD, ROCKFORD, IL 61103-1502
(872) 702-3523
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
08/22/2025
Last updated
03/11/2026
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