MEDICARE: 21ST CENTURY MEDICAL SUPPLIES 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1750461984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	21ST CENTURY MEDICAL SUPPLIES INC

Provider Business Mailing Address
First Line	:	PO BOX 1761
Second Line	:
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20717-1761
Country	:	US
Telephone Number	:	301-807-7987
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 JENNY BROOK CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-7245
Country	:	US
Telephone Number	:	301-807-7987
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WALTER CHARLES BOYD
Credential	:
Telephone Number	:	301-807-7987

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	03/08/2012

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