Organization
ILLIANA HOME MEDICAL EQUIPMENT AND SUPPLIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUDYARD SMITH MD (MEMBER)
(773) 778-8800
Entity
Organization
Contact information
Practice address
3510 W 79TH ST, CHICAGO, IL 60652-1430
(773) 778-8800
(773) 778-8808
Mailing address
3510 W 79TH ST, CHICAGO, IL 60652-1430
(773) 778-8800
(773) 778-8808
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
203.000570
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203.000570
LICENSE NO
IL
Enumeration date
06/17/2006
Last updated
03/07/2012
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