Organization
NORTHERN ILLINOIS HOME MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT LESAGE (PRESIDENT)
(815) 284-8200
Entity
Organization
Contact information
Practice address
1309 N GALENA AVE, DIXON, IL 61021-1060
(815) 285-5857
(815) 285-5858
Mailing address
1309 N GALENA AVE, DIXON, IL 61021-1060
(815) 285-5857
(815) 285-5858
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
072724
HEALTH ALLIANCE MED PLANS
—
01
—
09832001
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/16/2005
Last updated
08/22/2020
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