MEDICARE: CENTURY CARE PEN THERAPY 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
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	000460726	NC

General Provider Information

NPI Number	:	1083682835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTURY CARE PEN THERAPY INC

Provider Business Mailing Address
First Line	:	130 EDINBURGH SOUTH DR
Second Line	:	SUITE 208
City	:	CARY
State	:	NC
Zip	:	27511-7902
Country	:	US
Telephone Number	:	919-467-8686
Fax Number	:	919-467-9109

Provider Business Practice Location Address
First Line	:	130 EDINBURGH SOUTH DR
Second Line	:	SUITE 208
City	:	CARY
State	:	NC
Zip	:	27511-7902
Country	:	US
Telephone Number	:	919-467-8686
Fax Number	:	919-467-9109

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT E GILLIAM
Credential	:
Telephone Number	:	919-467-8686

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	09/06/2013

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