Provider Demographics
NPI:1982774923
Name:BAY STATE BRACE CO INC
Entity Type:Organization
Organization Name:BAY STATE BRACE CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:KRUPA
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:781-224-3505
Mailing Address - Street 1:599 NORTH AVE
Mailing Address - Street 2:DOOR 9 2ND FLOOR
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1648
Mailing Address - Country:US
Mailing Address - Phone:781-224-3505
Mailing Address - Fax:781-224-3507
Practice Address - Street 1:599 NORTH AVE
Practice Address - Street 2:DOOR 9 2ND FLOOR
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1622
Practice Address - Country:US
Practice Address - Phone:781-224-3505
Practice Address - Fax:781-224-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1541285Medicaid
MA1541285Medicaid