Provider Demographics
NPI:1285722090
Name:MEDELA , INC.
Entity type:Organization
Organization Name:MEDELA , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARR LANE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUACKENBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-435-8316
Mailing Address - Street 1:P.O. BOX 0160
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-0160
Mailing Address - Country:US
Mailing Address - Phone:800-435-8316
Mailing Address - Fax:815-363-2487
Practice Address - Street 1:1101 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7006
Practice Address - Country:US
Practice Address - Phone:800-435-8316
Practice Address - Fax:815-363-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1285722090Medicaid
SCDM1269Medicaid
SCDM1269Medicaid
IL=========001Medicaid