MEDICARE: 1918 WINTER STREET OPERATING CO 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
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1902654874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1918 WINTER STREET OPERATING CO LLC

Provider Business Mailing Address
First Line	:	7 CORPORATE DR
Second Line	:
City	:	KEENE
State	:	NH
Zip	:	03431-5042
Country	:	US
Telephone Number	:	603-354-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6730 N HUALAPAI WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-1358
Country	:	US
Telephone Number	:	208-395-6200
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED PERSON
Name	:	KEVIN MCNAMARA
Credential	:
Telephone Number	:	603-354-4619

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	07/24/2024

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