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Organization

PRAIRIE MEDICAL SUPPLY INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. SHARON S MANDLI (OWNER)
(217) 454-0479
Entity
Organization

Contact information

Practice address
120 LEWIS PARK DR, MT ZION, IL 62549-1202
(217) 864-0738
(217) 864-0743
Mailing address
120 LEWIS PARK PLAZA, MT ZION, IL 62549
(217) 864-0738
(217) 864-0743

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
05827243
BCBS OF IL
IL
Enumeration date
03/14/2006
Last updated
08/22/2020
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