MEDICARE: EMERALD MEDICAL SERVICES 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578584306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD MEDICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	4211 9TH ST NW
Second Line	:	SUITE 1
City	:	WASHINGTON
State	:	DC
Zip	:	20011-7200
Country	:	US
Telephone Number	:	202-722-8877
Fax Number	:	202-722-8819

Provider Business Practice Location Address
First Line	:	4211 9TH ST NW
Second Line	:	SUITE 1
City	:	WASHINGTON
State	:	DC
Zip	:	20011-7200
Country	:	US
Telephone Number	:	202-722-8877
Fax Number	:	202-722-8819

Authorized Official
Title or Position	:	CEO
Name	:	MR. UCHE BEN ODUNZEH
Credential	:
Telephone Number	:	202-722-8877

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	03/10/2008

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