Provider Demographics
NPI:1649227273
Name:BEVERLY SURGICAL SUPPLIES INC
Entity Type:Organization
Organization Name:BEVERLY SURGICAL SUPPLIES INC
Other - Org Name:BEVERLY MEDICAL SUPPLIES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:JALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-922-1022
Mailing Address - Street 1:5 ELM ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4405
Mailing Address - Country:US
Mailing Address - Phone:978-922-1022
Mailing Address - Fax:978-921-9150
Practice Address - Street 1:5 ELM ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4405
Practice Address - Country:US
Practice Address - Phone:978-922-1022
Practice Address - Fax:978-921-9150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1540599Medicaid
MAA08002392Medicare ID - Type UnspecifiedSUBMITTER NUMBER
MA1540599Medicaid