Provider Demographics
NPI:1841274511
Name:RANDALL A. GUERRA, INC.
Entity type:Organization
Organization Name:RANDALL A. GUERRA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:978-352-4840
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:615 MAIN STREET
Mailing Address - City:WEST BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01885-0305
Mailing Address - Country:US
Mailing Address - Phone:978-352-4840
Mailing Address - Fax:978-352-9713
Practice Address - Street 1:615 MAIN ST
Practice Address - Street 2:
Practice Address - City:BOXFORD
Practice Address - State:MA
Practice Address - Zip Code:01921-1110
Practice Address - Country:US
Practice Address - Phone:978-352-4840
Practice Address - Fax:978-352-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAN/A332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1527029Medicaid
MA0000202254OtherBLUE CROSS BLUE SHIELD MA
MA0000202254OtherBLUE CROSS BLUE SHIELD MA