Provider Demographics
NPI:1437329844
Name:DR LEE S CASPER
Entity Type:Organization
Organization Name:DR LEE S CASPER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DR LEE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CASPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-584-6400
Mailing Address - Street 1:207 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2926
Mailing Address - Country:US
Mailing Address - Phone:508-584-6400
Mailing Address - Fax:
Practice Address - Street 1:207 QUINCY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2926
Practice Address - Country:US
Practice Address - Phone:508-584-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9726578Medicaid
0462350001Medicare NSC