Healthcare Provider Details

I. General information

NPI: 1477505931
Provider Name (Legal Business Name): BOAS SURGICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E BOOT RD STE 300C
WEST CHESTER PA
19380-5931
US

IV. Provider business mailing address

PO BOX 650846
DALLAS TX
75265-0846
US

V. Phone/Fax

Practice location:
  • Phone: 610-696-5650
  • Fax: 610-696-5652
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number6000006653
License Number StatePA

VIII. Authorized Official

Name: JENNIFER L SIMMONS
Title or Position: REGULATORY COMPLIANCE ANALYST III
Credential:
Phone: 859-594-2709