Provider Demographics
NPI:1558320911
Name:A & E MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:A & E MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:AKSELRUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-205-0011
Mailing Address - Street 1:1832 TECHNY CT
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5474
Mailing Address - Country:US
Mailing Address - Phone:773-205-0011
Mailing Address - Fax:773-205-0044
Practice Address - Street 1:1832 TECHNY CT
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5474
Practice Address - Country:US
Practice Address - Phone:773-205-0011
Practice Address - Fax:773-205-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000698332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635220OtherBC/BS OF IL
IN200531540AMedicaid
FLN318253OtherWELLCARE (HARMONY HEALTH)
WI=========OtherHUMANA
IL=========001Medicaid
IL1635220OtherBC/BS OF IL
IL5409810001Medicare NSC