Provider Demographics
NPI:1609626167
Name:CENTENNIAL MED SUPPLY LLC
Entity Type:Organization
Organization Name:CENTENNIAL MED SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGYAR
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:701-367-8519
Mailing Address - Street 1:1805 S BELLAIRE ST STE 480-01
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4305
Mailing Address - Country:US
Mailing Address - Phone:720-443-0841
Mailing Address - Fax:
Practice Address - Street 1:1805 S BELLAIRE ST STE 480-01
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4305
Practice Address - Country:US
Practice Address - Phone:720-443-0841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies