Provider Demographics
NPI:1467500777
Name:INFINITE MEDICAL SUPPLY COMPANY
Entity type:Organization
Organization Name:INFINITE MEDICAL SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-912-6646
Mailing Address - Street 1:7177 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2210
Mailing Address - Country:US
Mailing Address - Phone:847-912-6646
Mailing Address - Fax:847-674-9888
Practice Address - Street 1:7177 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2210
Practice Address - Country:US
Practice Address - Phone:847-912-6646
Practice Address - Fax:847-674-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5879660001OtherNATIONAL GOVERNMENT SERVICES
IL203000887OtherSTATE OF ILLINOIS LICENSE
IL203000887OtherSTATE OF ILLINOIS LICENSE
IL5879660001Medicare Oscar/Certification
IL5879660001OtherNATIONAL GOVERNMENT SERVICES