NPIViewer - Provider NPI 1811997638

NPI:	1811997638
Name:	MEDLINE INDUSTRIES, LP
Entity type:	Organization
Organization Name:	MEDLINE INDUSTRIES, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:	AUTHORIZED PERSON
Authorized Official - Prefix:
Authorized Official - First Name:	JAMES
Authorized Official - Middle Name:	MICHAEL
Authorized Official - Last Name:	BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	844-265-6512
Mailing Address - Street 1:	3 LAKES DR
Mailing Address - Street 2:
Mailing Address - City:	NORTHFIELD
Mailing Address - State:	IL
Mailing Address - Zip Code:	60093-2753
Mailing Address - Country:	US
Mailing Address - Phone:	844-265-6512
Mailing Address - Fax:
Practice Address - Street 1:	2200 CORNERSTONE PKWY
Practice Address - Street 2:
Practice Address - City:	GRAYSLAKE
Practice Address - State:	IL
Practice Address - Zip Code:	60030-9712
Practice Address - Country:	US
Practice Address - Phone:	224-327-8800
Practice Address - Fax:
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2005-07-22
Last Update Date:	2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:

State	License ID	Taxonomies
		332B00000X
IL	203001682	332B00000X

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

State	Identifier ID	ID Type
WA	1811997638	Medicaid
UT	1811997638	Medicaid
DE	1811997638	Medicaid
KY	90032335	Medicaid
NE	00	Medicaid
MS	00410369	Medicaid
AK	1021896	Medicaid
WI	1811997638	Medicaid
IA	1811997638	Medicaid
AR	194904716	Medicaid
LA	2429400	Medicaid
CO	98000060	Medicaid
WY	143546900	Medicaid
ID	1811997638	Medicaid
ME	1811997638	Medicaid
PA	0009052300005	Medicaid
GA	00457949A	Medicaid
NY	00680891	Medicaid
AZ	036021	Medicaid
OH	0400435	Medicaid
MN	1811997638	Medicaid
AL	1811997638	Medicaid
FL	021743300	Medicaid
OK	100793800A	Medicaid
VA	1811997638	Medicaid
NJ	5096901	Medicaid
NM	000T0700	Medicaid
RI	0428930	Medicaid
KS	100441690A	Medicaid
MT	1811997638	Medicaid
CA	0623240	Medicaid
IN	100025130A	Medicaid
OK	100973800A	Medicaid
TN	3539772	Medicaid
MO	620803601	Medicaid
IL	001	Medicaid
MD	033388300	Medicaid
NV	1811997638	Medicaid
NH	3098855	Medicaid
DE	1811997638	Medicaid