1831293208 NPI number — BAY STATE MEDICAL EQUIPMENT DISTRIBUTORS

Table of content: (NPI 1831293208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831293208 NPI number — BAY STATE MEDICAL EQUIPMENT DISTRIBUTORS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY STATE MEDICAL EQUIPMENT DISTRIBUTORS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831293208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
681 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02301-2407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-427-5772
Provider Business Mailing Address Fax Number:
508-427-6362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
681 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02301-2407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-427-5772
Provider Business Practice Location Address Fax Number:
508-427-6362
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/PARTNER
Authorized Official Telephone Number:
508-427-5772

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000033555 . This is a "BOS. MED. HEALTHNET PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 004130 . This is a "SENIOR WHOLE HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 95531801 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1542214 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1831293208 . This is a "COMMONWEALTH CARE ALLIANCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0039743 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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