Provider Demographics
NPI:1659477107
Name:MEDSTAR SURGICAL & BREATHING EQUIPMENT, INC.
Entity Type:Organization
Organization Name:MEDSTAR SURGICAL & BREATHING EQUIPMENT, INC.
Other - Org Name:GENOX HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOREE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:855-914-9140
Mailing Address - Street 1:82 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2425
Mailing Address - Country:US
Mailing Address - Phone:860-444-4965
Mailing Address - Fax:860-444-4969
Practice Address - Street 1:82 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2425
Practice Address - Country:US
Practice Address - Phone:860-444-4965
Practice Address - Fax:860-444-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004021267Medicaid
CT004021267Medicaid
0125830007Medicare NSC