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General NPI Number Information
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NPI Number | 1659477107
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Entity Type | Organization
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Legal Business Name | MEDSTAR SURGICAL & BREATHING EQUIPMENT, INC.
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 82 BOSTON POST RD
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City | WATERFORD
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State | CT
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Zip | 06385-2425
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Country | US
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Telephone | 860-444-4965
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Fax | 860-444-4969
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Provider Business Mailing Address
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Address Line | 82 BOSTON POST RD
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City | WATERFORD
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State | CT
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Zip | 06385-2425
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Country | US
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Telephone | 860-444-4965
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Fax | 860-444-4969
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LOREE ANDERSON
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Credential | MA
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Telephone | 855-914-9140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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