Provider Demographics
NPI:1275757882
Name:CAROLS IMAGE PLUS
Entity Type:Organization
Organization Name:CAROLS IMAGE PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:LABRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-592-3334
Mailing Address - Street 1:205 GRATTAN ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1335
Mailing Address - Country:US
Mailing Address - Phone:413-592-3334
Mailing Address - Fax:413-592-1009
Practice Address - Street 1:205 GRATTAN ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1335
Practice Address - Country:US
Practice Address - Phone:413-592-3334
Practice Address - Fax:413-592-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MA57201332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0342530001Medicare NSC
MA0342530001Medicare PIN