MEDICARE: SPRINGFIELD SURGICAL SUPPLY 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

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	:	1962568832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGFIELD SURGICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	127 15 MERRICK BLVD
Second Line	:
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11434-3421
Country	:	US
Telephone Number	:	718-528-7301
Fax Number	:	718-528-7399

Provider Business Practice Location Address
First Line	:	127 -15 MERRICK BLVD
Second Line	:
City	:	SPRINGFIELD GARDENS
State	:	NY
Zip	:	11434-3421
Country	:	US
Telephone Number	:	718-528-7301
Fax Number	:	718-528-7399

Authorized Official
Title or Position	:	OWNER
Name	:	SHATEL STEWART
Credential	:	OWNER
Telephone Number	:	718-528-7301

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	11/17/2011

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Directions to “SPRINGFIELD SURGICAL SUPPLY INC ” Practice Location

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