Healthcare Provider Details

I. General information

NPI: 1346295953
Provider Name (Legal Business Name): BYRAM HEALTHCARE CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 MILL ST SUITE A
WORCESTER MA
01602-3191
US

IV. Provider business mailing address

PO BOX 277596
ATLANTA GA
30384-7596
US

V. Phone/Fax

Practice location:
  • Phone: 508-756-8300
  • Fax: 888-233-1799
Mailing address:
  • Phone: 770-422-5516
  • Fax: 770-590-8563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1535803
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier4401008
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer

VIII. Authorized Official

Name: MR. PERRY A BERNOCCHI
Title or Position: CEO & PRESIDENT
Credential:
Phone: 732-302-1600