Provider Demographics
NPI:1750461984
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:OWNER
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:PO BOX 1761
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20717-1761
Mailing Address - Country:US
Mailing Address - Phone:301-807-7987
Mailing Address - Fax:
Practice Address - Street 1:506 JENNY BROOK CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-7245
Practice Address - Country:US
Practice Address - Phone:301-807-7987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies