Provider Demographics
NPI:1487633921
Name:FOX MED-EQUIP SERVICE CORP
Entity type:Organization
Organization Name:FOX MED-EQUIP SERVICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-345-0649
Mailing Address - Street 1:1832 VANDALIA ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-1490
Mailing Address - Country:US
Mailing Address - Phone:618-345-0649
Mailing Address - Fax:618-345-0694
Practice Address - Street 1:1832 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-1490
Practice Address - Country:US
Practice Address - Phone:618-345-0649
Practice Address - Fax:618-345-0694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO622114007Medicaid
MO622114007Medicaid
IL=========002Medicaid
IL0197800001Medicare ID - Type Unspecified