Organization
KCAMLAED MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL C MACK (CEO)
(708) 333-2498
Entity
Organization
Contact information
Practice address
16900 LATHROP AVE, HARVEY, IL 60426-6033
(708) 596-5671
(708) 596-5623
Mailing address
15341 4TH AVE, PHOENIX, IL 60426-2620
(708) 333-2498
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)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
12/31/2008
Last updated
12/29/2009
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