Provider Demographics
NPI:1952417636
Name:WILCOX MEDICAL, INC
Entity Type:Organization
Organization Name:WILCOX MEDICAL, INC
Other - Org Name:BIOSCRIP INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-879-6137
Mailing Address - Street 1:4222 PAYSPHERE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0042
Mailing Address - Country:US
Mailing Address - Phone:800-879-6137
Mailing Address - Fax:
Practice Address - Street 1:217 WOODSTOCK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3317
Practice Address - Country:US
Practice Address - Phone:802-775-2808
Practice Address - Fax:855-775-7824
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIOSCRIP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-22
Last Update Date:2023-10-31
Deactivation Date:2019-04-10
Deactivation Code:
Reactivation Date:2019-11-02
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X, 333600000X, 3336C0004X, 3336M0002X, 3336S0011X
VT038-00033913336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032274OtherLICENSE
VT1008328Medicaid
VT1004914Medicaid
VT038.0093947-HMIFOtherLICENSE
NY032274OtherLICENSE