MEDICARE: SCOTT MEDICAL SUPPLY 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	332BX2000X	Oxygen Equipment & Supplies (DME)		NY

General Provider Information

NPI Number	:	1649419367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	5221 AVENUE D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5917
Country	:	US
Telephone Number	:	347-404-6500
Fax Number	:	347-404-6501

Provider Business Practice Location Address
First Line	:	5221 AVENUE D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-5917
Country	:	US
Telephone Number	:	347-404-6500
Fax Number	:	347-404-6501

Authorized Official
Title or Position	:	MANGER
Name	:	MR. WENDELL FREDERICK
Credential	:
Telephone Number	:	347-404-6500

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	07/21/2022

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