Provider Demographics
NPI:1114018785
Name:FITZSIMMONS SURGICAL SUPPLY INC
Entity type:Organization
Organization Name:FITZSIMMONS SURGICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FITZSIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-532-1199
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-7927
Mailing Address - Country:US
Mailing Address - Phone:708-532-1199
Mailing Address - Fax:708-532-4411
Practice Address - Street 1:8000 186TH ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-9215
Practice Address - Country:US
Practice Address - Phone:708-532-1199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1670010OtherBLUE CROSS/BLUE SHIELD
IL1670010OtherBLUE CROSS/BLUE SHIELD
1114018785Medicare NSC
IL=========Medicaid