Provider Demographics
NPI:1831293208
Name:BAY STATE MEDICAL EQUIPMENT DISTRIBUTORS
Entity Type:Organization
Organization Name:BAY STATE MEDICAL EQUIPMENT DISTRIBUTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:CFTS
Authorized Official - Phone:508-427-5772
Mailing Address - Street 1:681 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2407
Mailing Address - Country:US
Mailing Address - Phone:508-427-5772
Mailing Address - Fax:508-427-6362
Practice Address - Street 1:681 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2407
Practice Address - Country:US
Practice Address - Phone:508-427-5772
Practice Address - Fax:508-427-6362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000033555OtherBOS. MED. HEALTHNET PLAN
MA004130OtherSENIOR WHOLE HEALTH
MA95531801OtherNETWORK HEALTH
MA1542214Medicaid
MA1831293208OtherCOMMONWEALTH CARE ALLIANCE
MA0039743OtherNEIGHBORHOOD HEALTH PLAN
MA1542214Medicaid