Provider Demographics
NPI:1427209279
Name:MBS ORTHOPEDIC SPECIALTY, LLC
Entity Type:Organization
Organization Name:MBS ORTHOPEDIC SPECIALTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:443-759-3119
Mailing Address - Street 1:400 E PRATT ST
Mailing Address - Street 2:SUITE 819
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3116
Mailing Address - Country:US
Mailing Address - Phone:443-759-3119
Mailing Address - Fax:443-759-3199
Practice Address - Street 1:400 E PRATT ST
Practice Address - Street 2:SUITE 819
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3116
Practice Address - Country:US
Practice Address - Phone:443-759-3119
Practice Address - Fax:443-759-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment