Provider Demographics
NPI:1417039819
Name:ST REGIS MEDICAL EQUIPMENT CORP
Entity Type:Organization
Organization Name:ST REGIS MEDICAL EQUIPMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-732-7040
Mailing Address - Street 1:233 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-2211
Mailing Address - Country:US
Mailing Address - Phone:315-732-7040
Mailing Address - Fax:
Practice Address - Street 1:233 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-2211
Practice Address - Country:US
Practice Address - Phone:315-732-7040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01194509Medicaid
NY01194509Medicaid