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General NPI Number Information
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NPI Number | 1225261191
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Entity Type | Organization
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Legal Business Name | COLUMBIA MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 10630 LITTLE PATUXENT PKWY STE. 116
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City | COLUMBIA
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State | MD
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Zip | 21044-6208
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Country | US
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Telephone | 410-992-7730
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Fax | 410-992-7731
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Provider Business Mailing Address
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Address Line | 10630 LITTLE PATUXENT PKWY STE. 116
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City | COLUMBIA
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State | MD
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Zip | 21044-6208
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Country | US
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Telephone | 410-992-7730
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Fax | 410-992-7731
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. PHILLIP NICOLAS
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Credential | D.C.
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Telephone | 410-992-7730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 03382
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License Number State | MD
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