MEDICARE: CHOICE ONE MEDICAL SUPPLY 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
1	332B00000X	Durable Medical Equipment & Medical Supplies		DC

General Provider Information

NPI Number	:	1245485952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICE ONE MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	2248 CHESTER ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5704
Country	:	US
Telephone Number	:	202-365-5322
Fax Number	:

Provider Business Practice Location Address
First Line	:	2248 CHESTER ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5704
Country	:	US
Telephone Number	:	202-365-5322
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MCKELL BEAMON
Credential	:
Telephone Number	:	202-365-5322

Provider Enumeration Date	:	11/21/2008
Last Update Date	:	11/21/2008

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