MEDICARE: GREENWAY 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1780903567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWAY MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	2570 86TH ST
Second Line	:	1ST FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2570 86TH ST
Second Line	:	1ST FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4438
Country	:	US
Telephone Number	:	718-303-8998
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. VLADIMIR NAZAROV
Credential	:
Telephone Number	:	718-303-8998

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	05/19/2010

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