MEDICARE: OCEAN STATE REHAB EQUIPMENT 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	00	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225097330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN STATE REHAB EQUIPMENT INC

Provider Business Mailing Address
First Line	:	197 PUTNAM PIKE
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-1468
Country	:	US
Telephone Number	:	401-231-7100
Fax Number	:	401-231-0763

Provider Business Practice Location Address
First Line	:	197 PUTNAM PIKE
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-1468
Country	:	US
Telephone Number	:	401-231-7100
Fax Number	:	401-231-0763

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAMON JOHN BRADLEY
Credential	:
Telephone Number	:	401-231-7100

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	07/21/2022

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