MEDICARE: CENTURY 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001635718	OTHER	IL	BCBS OF IL

General Provider Information

NPI Number	:	1992876171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTURY MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	6032 S HALSTED ST
Second Line	:	#104
City	:	CHICAGO
State	:	IL
Zip	:	60621-2112
Country	:	US
Telephone Number	:	773-723-6695
Fax Number	:	773-723-6694

Provider Business Practice Location Address
First Line	:	6032 S HALSTED ST
Second Line	:	#104
City	:	CHICAGO
State	:	IL
Zip	:	60621-2112
Country	:	US
Telephone Number	:	773-723-6695
Fax Number	:	773-723-6694

Authorized Official
Title or Position	:	OWNER AND MANAGER
Name	:	MS. DUOYOU L LIU
Credential	:
Telephone Number	:	312-498-7683

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	08/22/2020

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