Provider Demographics
NPI:1790986958
Name:SURGI-CARE INC
Entity Type:Organization
Organization Name:SURGI-CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DILIDDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-290-1807
Mailing Address - Street 1:71 FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1105
Mailing Address - Country:US
Mailing Address - Phone:800-797-8744
Mailing Address - Fax:800-338-6304
Practice Address - Street 1:12 GREGORY DR
Practice Address - Street 2:UNIT 2
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6058
Practice Address - Country:US
Practice Address - Phone:800-797-8744
Practice Address - Fax:800-338-6304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGI-CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-29
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008716Medicaid
VT29240OtherBCBS
MA0254690001Medicare NSC