Provider Demographics
NPI:1316443559
Name:MEDICAL SHIPMENT, LLC
Entity type:Organization
Organization Name:MEDICAL SHIPMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MICIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-253-3000
Mailing Address - Street 1:70 LIVELY BLVD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1619
Mailing Address - Country:US
Mailing Address - Phone:847-253-3000
Mailing Address - Fax:847-506-0524
Practice Address - Street 1:70 LIVELY BLVD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-1619
Practice Address - Country:US
Practice Address - Phone:847-253-3000
Practice Address - Fax:847-506-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL004.003232332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies