Healthcare Provider Details

I. General information

NPI: 1528494853
Provider Name (Legal Business Name): 21ST CENTURY MEDICAL SUPPLIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 APOLLO DR STE 100
LARGO MD
20774-4785
US

IV. Provider business mailing address

9701 APOLLO DR STE 100
LARGO MD
20774-4785
US

V. Phone/Fax

Practice location:
  • Phone: 301-807-7987
  • Fax: 301-880-4700
Mailing address:
  • Phone: 301-807-7987
  • Fax: 301-880-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. WALTER CHARLES BOYD
Title or Position: DIRECTOR MARKETING AND SALES
Credential:
Phone: 301-807-7987