MEDICARE: ATLANTIS MEDICAL SUPPLY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1376059584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIS MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	692 HANCOCK ST
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02170-2814
Country	:	US
Telephone Number	:	877-611-5333
Fax Number	:	877-611-5333

Provider Business Practice Location Address
First Line	:	692 HANCOCK ST
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02170-2814
Country	:	US
Telephone Number	:	877-611-5333
Fax Number	:	877-611-5333

Authorized Official
Title or Position	:	CEO
Name	:	DR. MUIZ KHIR
Credential	:	M.D.
Telephone Number	:	617-407-2323

Provider Enumeration Date	:	12/26/2017
Last Update Date	:	12/26/2017

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