Provider Demographics
NPI:1356610828
Name:MED RAC'S
Entity type:Organization
Organization Name:MED RAC'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:EDCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-733-3809
Mailing Address - Street 1:300 CONGRESS STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:781-733-3809
Mailing Address - Fax:617-471-7041
Practice Address - Street 1:300 CONGRESS STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:781-733-3809
Practice Address - Fax:617-471-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78177207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9705554Medicaid
MAE84202Medicare UPIN
MAM16145Medicare PIN