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NPI Code Detail

MEDICARE: POTOMAC SUPPLY COMPANY LLC

MEDICARE: POTOMAC SUPPLY COMPANY LLC
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
1332BC3200XCustomized Equipment (DME)
2332BD1200XDialysis Equipment & Supplies (DME)
3332BN1400XNursing Facility Supplies (DME)
4332BX2000XOxygen Equipment & Supplies (DME)
5332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1215596085
Entity Type Code : Organization
Provider Name (Legal Business Name) : POTOMAC SUPPLY COMPANY LLC
Provider Business Mailing Address
First Line : 820 H ST NE STE 201
Second Line :
City : WASHINGTON
State : DC
Zip : 20002-3629
Country : US
Telephone Number : 202-341-6070
Fax Number : 888-395-0772
Provider Business Practice Location Address
First Line : 820 H ST NE STE 201
Second Line :
City : WASHINGTON
State : DC
Zip : 20002-3629
Country : US
Telephone Number : 202-341-6070
Fax Number : 888-395-0772
Authorized Official
Title or Position : PRESIDENT
Name : MR. OKERA KWABENA STEWART
Credential :
Telephone Number : 202-341-6070
Provider Enumeration Date : 06/06/2019
Last Update Date : 06/06/2019

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Directions to “POTOMAC SUPPLY COMPANY LLC ” Practice Location

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