Provider Demographics
NPI:1699904896
Name:ARMOR MEDICAL SUPPLY LLC CHICAGO SOUTH
Entity type:Organization
Organization Name:ARMOR MEDICAL SUPPLY LLC CHICAGO SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBREL
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-331-7111
Mailing Address - Street 1:16643 S KEDZIE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MARKHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60428-5512
Mailing Address - Country:US
Mailing Address - Phone:708-331-7111
Mailing Address - Fax:708-331-7112
Practice Address - Street 1:16643 S KEDZIE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MARKHAM
Practice Address - State:IL
Practice Address - Zip Code:60428-5512
Practice Address - Country:US
Practice Address - Phone:708-331-7111
Practice Address - Fax:708-331-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203001131332B00000X
IN69000903A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6042801Medicaid
IL6327260001Medicare NSC