Provider Demographics
NPI:1407668379
Name:MILES OF CARE SOUTHWEST
Entity type:Organization
Organization Name:MILES OF CARE SOUTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TAMMISHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-438-2525
Mailing Address - Street 1:P.O. BOX 437432
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:ILLINOIS
Mailing Address - Zip Code:60643
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10408 S WESTERN AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2508
Practice Address - Country:US
Practice Address - Phone:844-438-2525
Practice Address - Fax:708-933-3459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILES OF CARE DIVISIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-27
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier