Provider Demographics
NPI:1245234970
Name:STEVE GULICK INC
Entity type:Organization
Organization Name:STEVE GULICK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-442-0121
Mailing Address - Street 1:PO BOX 1307
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-1307
Mailing Address - Country:US
Mailing Address - Phone:217-442-0121
Mailing Address - Fax:217-442-0022
Practice Address - Street 1:912 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3056
Practice Address - Country:US
Practice Address - Phone:217-442-0121
Practice Address - Fax:217-442-0022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ILLIANA MEDICAL EQUIPMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-10
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1226440001Medicare NSC