Provider Demographics
NPI:1336270974
Name:BEAUDETTE HOME MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:BEAUDETTE HOME MEDICAL SUPPLY, INC.
Other - Org Name:MCCORD SWEENEY HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-458-4163
Mailing Address - Street 1:850 CHELMSFORD ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-5149
Mailing Address - Country:US
Mailing Address - Phone:978-458-4163
Mailing Address - Fax:978-458-4759
Practice Address - Street 1:850 CHELMSFORD ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-5149
Practice Address - Country:US
Practice Address - Phone:978-458-4163
Practice Address - Fax:978-458-4759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1540351Medicaid
MA1540351Medicaid