Provider Demographics
NPI:1528494853
Name:21ST CENTURY MEDICAL SUPPLIES, INC
Entity type:Organization
Organization Name:21ST CENTURY MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MARKETING AND SALES
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-807-7987
Mailing Address - Street 1:9701 APOLLO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4785
Mailing Address - Country:US
Mailing Address - Phone:301-807-7987
Mailing Address - Fax:301-880-4700
Practice Address - Street 1:9701 APOLLO DR STE 100
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4785
Practice Address - Country:US
Practice Address - Phone:301-807-7987
Practice Address - Fax:301-880-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment