Provider Demographics
NPI:1598864555
Name:MEDICAL PRODUCTS GROUP INC
Entity type:Organization
Organization Name:MEDICAL PRODUCTS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN BUREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-284-9771
Mailing Address - Street 1:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-0764
Mailing Address - Country:US
Mailing Address - Phone:815-284-9771
Mailing Address - Fax:815-284-9725
Practice Address - Street 1:641 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-9139
Practice Address - Country:US
Practice Address - Phone:815-284-9771
Practice Address - Fax:815-284-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000437332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL4657680001Medicare NSC