Provider Demographics
NPI:1992161517
Name:MEDLINE INDUSTRIES, LP
Entity type:Organization
Organization Name:MEDLINE INDUSTRIES, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED PERSON
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
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:ATTN: HOMECARE COMPLIANCE
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:866-779-5827
Practice Address - Street 1:36445 VAN BORN RD STE 200
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-4051
Practice Address - Country:US
Practice Address - Phone:734-728-6396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies