Provider Demographics
NPI:1669746541
Name:WELLNESS MEDICAL SUPPLY
Entity type:Organization
Organization Name:WELLNESS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-757-7048
Mailing Address - Street 1:45 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505-1983
Mailing Address - Country:US
Mailing Address - Phone:508-757-7048
Mailing Address - Fax:978-443-4598
Practice Address - Street 1:45 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01505-1983
Practice Address - Country:US
Practice Address - Phone:508-757-7048
Practice Address - Fax:401-729-5940
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLNESS MEDICAL SUPPLY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-24
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA332B00000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110134416BMedicaid