Provider Demographics
NPI:1568579159
Name:GLYNN ORTHOPEDIC SERVICES
Entity Type:Organization
Organization Name:GLYNN ORTHOPEDIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:781-294-4270
Mailing Address - Street 1:4 MOUNTAIN AVE.
Mailing Address - Street 2:PO BOX 1348
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359
Mailing Address - Country:US
Mailing Address - Phone:781-294-4270
Mailing Address - Fax:781-293-6307
Practice Address - Street 1:4 MOUNTAIN AVE.
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359
Practice Address - Country:US
Practice Address - Phone:781-294-4270
Practice Address - Fax:781-293-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1528475Medicaid
MA272054OtherBLUE CROSS/BLUE SHIELD
MA602057OtherHARVARD PILGRIM
MA272054OtherBLUE CROSS/BLUE SHIELD