Provider Demographics
NPI:1811953102
Name:OCONNOR MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:OCONNOR MEDICAL SUPPLY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-274-0055
Mailing Address - Street 1:2660 WEST 53RD STREET
Mailing Address - Street 2:SUITE #4
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2660 E 53RD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3873
Practice Address - Country:US
Practice Address - Phone:563-355-3902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4589440002Medicare NSC