Provider Demographics
NPI:1003957416
Name:MEDICAL EQUIPMENT OF CENTERBROOK, LLC
Entity Type:Organization
Organization Name:MEDICAL EQUIPMENT OF CENTERBROOK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-767-2028
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:CENTERBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06409-0206
Mailing Address - Country:US
Mailing Address - Phone:860-767-2028
Mailing Address - Fax:860-767-2893
Practice Address - Street 1:33 MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERBROOK
Practice Address - State:CT
Practice Address - Zip Code:06409
Practice Address - Country:US
Practice Address - Phone:860-767-2028
Practice Address - Fax:860-767-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12DME0866CT01OtherANTHEM BCBS
CT5452820001Medicare NSC