MEDICARE: MASH INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R3471	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1275595738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASH INC

Provider Business Mailing Address
First Line	:	379 E NELSON AVE
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433
Country	:	US
Telephone Number	:	850-892-5773
Fax Number	:	850-892-6318

Provider Business Practice Location Address
First Line	:	379 E NELSON AVE
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433
Country	:	US
Telephone Number	:	850-892-5773
Fax Number	:	850-892-6318

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEVEN W ALVERSON
Credential	:
Telephone Number	:	205-664-2059

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	08/22/2020

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Directions to “MASH INC ” Practice Location

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