Provider Demographics
NPI:1992922348
Name:BLOOMINGROSE MEDICAL SUPPLIES AND HOSPITAL EQUIPMENT COMAPANY
Entity type:Organization
Organization Name:BLOOMINGROSE MEDICAL SUPPLIES AND HOSPITAL EQUIPMENT COMAPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SALES
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-888-3155
Mailing Address - Street 1:19 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5413
Mailing Address - Country:US
Mailing Address - Phone:847-888-3155
Mailing Address - Fax:847-214-2857
Practice Address - Street 1:19 N STATE ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5413
Practice Address - Country:US
Practice Address - Phone:847-888-3155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.000727332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL5563830001Medicare ID - Type Unspecified