Provider Demographics
NPI:1790979201
Name:STRIDE MEDICAL INC
Entity Type:Organization
Organization Name:STRIDE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OSAZEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOGHIREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-469-3574
Mailing Address - Street 1:291 CUMMINS HWY
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3843
Mailing Address - Country:US
Mailing Address - Phone:617-469-3574
Mailing Address - Fax:
Practice Address - Street 1:291 CUMMINS HIGHWAY
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3843
Practice Address - Country:US
Practice Address - Phone:617-469-3574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000914053332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5750030001Medicare NSC