Organization
ITAC MEDICAL SUPPLY COMPANY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHIQUITA LEE (CEO)
(312) 340-8826
Entity
Organization
Contact information
Practice address
5113 S. HARPER AVE, STE. 2C, CHICAGO, IL 60615
(312) 340-8826
Mailing address
9449 S KEDZIE AVE STE 357, EVERGREEN PARK, IL 60805-2325
(312) 340-8826
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
=========
DME
—
Enumeration date
04/24/2018
Last updated
02/18/2025
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