Provider Demographics
NPI:1912725995
Name:AVID MEDICAL SUPPLIES LLC
Entity type:Organization
Organization Name:AVID MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:DEMONTEVERDE
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-532-3911
Mailing Address - Street 1:67 S SUTTON RD.
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107
Mailing Address - Country:US
Mailing Address - Phone:847-532-3911
Mailing Address - Fax:
Practice Address - Street 1:67 S SUTTON RD.
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107
Practice Address - Country:US
Practice Address - Phone:224-769-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies