Organization
ORTHOPEDIC REHABILITATION SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK HANSON (OWNER)
(309) 310-8648
Entity
Organization
Contact information
Practice address
13 NORBLOOM AVE, BLOOMINGTON, IL 61701-1949
(309) 310-8648
Mailing address
13 NORBLOOM AVE, BLOOMINGTON, IL 61701-1949
(309) 310-8648
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
LC1242724
MO
Other
Enumeration date
02/12/2018
Last updated
02/12/2018
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