MEDICARE: KINGS ENTERPRIZE

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		MA

General Provider Information

NPI Number	:	1861509663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS ENTERPRIZE

Provider Business Mailing Address
First Line	:	1354 HANCOCK ST
Second Line	:	207
City	:	QUINCY
State	:	MA
Zip	:	02169-5109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1354 HANCOCK ST
Second Line	:	207
City	:	QUINCY
State	:	MA
Zip	:	02169-5109
Country	:	US
Telephone Number	:	617-471-0911
Fax Number	:	617-471-0977

Authorized Official
Title or Position	:	OWNER
Name	:	KINGSLEY T EZE
Credential	:
Telephone Number	:	617-471-0911

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/21/2022

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Directions to “KINGS ENTERPRIZE ” Practice Location

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