Provider Demographics
NPI:1245215987
Name:WILLIAM J FREDERICKS JR
Entity Type:Organization
Organization Name:WILLIAM J FREDERICKS JR
Other - Org Name:ALLCARE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FREDERICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-865-4857
Mailing Address - Street 1:30 GRAFTON ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-3918
Mailing Address - Country:US
Mailing Address - Phone:508-865-4857
Mailing Address - Fax:508-865-6370
Practice Address - Street 1:30 GRAFTON ST
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-3918
Practice Address - Country:US
Practice Address - Phone:508-865-4857
Practice Address - Fax:508-865-6370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1539353Medicaid
MA1539353Medicaid