Organization
E & S MEDICAL SUPPLY CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEFOREST WAYNE SHOBE (PRESIDENT)
(219) 395-1026
Entity
Organization
Contact information
Practice address
500 BROADWAY STE B, CHESTERTON, IN 46304-2393
(219) 395-1026
(219) 395-1625
Mailing address
500 BROADWAY, STE B, CHESTERTON, IN 46304-2393
(219) 395-1026
(219) 395-1625
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0007209908
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200211710A
—
IN
Enumeration date
09/21/2006
Last updated
01/07/2010
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