MEDICARE: POTOMAC VALLEY HOME MEDICAL INC.

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	335E00000X	Prosthetic/Orthotic Supplier
2	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L0005158	OTHER	MD	MD LICENSE

General Provider Information

NPI Number	:	1396329579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POTOMAC VALLEY HOME MEDICAL INC.

Provider Business Mailing Address
First Line	:	6721 SERVICEBERRY DR
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-7996
Country	:	US
Telephone Number	:	240-644-8664
Fax Number	:	301-722-4787

Provider Business Practice Location Address
First Line	:	6310 STEVENS FOREST RD
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21046-1036
Country	:	US
Telephone Number	:	301-722-6300
Fax Number	:	301-722-4787

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WALEED ADNAN BEIDAS
Credential	:
Telephone Number	:	301-722-6300

Provider Enumeration Date	:	05/12/2021
Last Update Date	:	05/12/2021

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