MEDICARE: BOAS SURGICAL, 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
2	335E00000X	Prosthetic/Orthotic Supplier	6000007135	PA

General Provider Information

NPI Number	:	1578740551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOAS SURGICAL, INC.

Provider Business Mailing Address
First Line	:	PO BOX 650846
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5970 LEMON ST
Second Line	:
City	:	EAST PETERSBURG
State	:	PA
Zip	:	17520-1316
Country	:	US
Telephone Number	:	717-239-1570
Fax Number	:	717-239-1572

Authorized Official
Title or Position	:	REGULATORY COMPLIANCE ANALYST III
Name	:	JENNIFER L SIMMONS
Credential	:
Telephone Number	:	859-594-2709

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	12/15/2025

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