Provider Demographics
NPI:1841824802
Name:COVENANT MED DEVICES AND SUPPLIES, INC.
Entity type:Organization
Organization Name:COVENANT MED DEVICES AND SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MACHU
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMAKRISHNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-256-0682
Mailing Address - Street 1:2630 FLOSSMOOR RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1560
Mailing Address - Country:US
Mailing Address - Phone:708-816-8452
Mailing Address - Fax:
Practice Address - Street 1:2630 FLOSSMOOR RD STE 101
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1560
Practice Address - Country:US
Practice Address - Phone:708-816-8452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL47-4566435001Medicaid