Provider Demographics
NPI:1821050386
Name:MASH INC
Entity Type:Organization
Organization Name:MASH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-664-2059
Mailing Address - Street 1:242 NE RACETRACK RD
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547
Mailing Address - Country:US
Mailing Address - Phone:850-863-4515
Mailing Address - Fax:850-863-1319
Practice Address - Street 1:242 NE RACETRACK RD
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-863-4515
Practice Address - Fax:850-863-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027450000Medicaid
FL672312896Medicaid
FL201611701Medicaid
FL672312898Medicaid
FLR3414OtherBLUE CROSS BLUE SHIELD
FL672310196Medicaid
FL=========OtherTRICARE
FL672310196Medicaid