Provider Demographics
NPI:1831476803
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 1:2170 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1477
Mailing Address - Country:US
Mailing Address - Phone:800-834-4311
Mailing Address - Fax:716-656-1330
Practice Address - Street 1:125 MASARIK AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615-7250
Practice Address - Country:US
Practice Address - Phone:203-377-5849
Practice Address - Fax:203-386-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008040350332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008040350Medicaid
CT0125830002Medicare NSC