Provider Demographics
NPI:1871575563
Name:MASS SURGICAL SUPPLY, LLC
Entity type:Organization
Organization Name:MASS SURGICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-532-1401
Mailing Address - Street 1:249 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6513
Mailing Address - Country:US
Mailing Address - Phone:413-532-1401
Mailing Address - Fax:413-532-1128
Practice Address - Street 1:249 HIGH ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6513
Practice Address - Country:US
Practice Address - Phone:413-532-1401
Practice Address - Fax:413-532-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000020453OtherBMC HEALTHNET
MA0000167954OtherBCBS OF MA
MA32385OtherHEALTH NEW ENGLAND
MA32385OtherHEALTH NEW ENGLAND
MA000000020453OtherBMC HEALTHNET
MA0178800001Medicare ID - Type Unspecified