Springfield Surgical Supply, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

1249907 Issued in NY

Legal business name

SPRINGFIELD SURGICAL SUPPLY, INC.

Practice address

12715 Merrick Blvd
Jamaica, NY 11434-3421

Phone

(718) 528-7301

Fax

(718) 528-7399

NPI assigned

Aug 18, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Shatel Stewart

Title

Owner

Phone

(718) 528-7301

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313625600000",
    "number": "1699055905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12715 MERRICK BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114343421",
            "telephone_number": "718-528-7301",
            "fax_number": "718-528-7399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12715 MERRICK BLVD",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114343421",
            "telephone_number": "718-528-7301",
            "fax_number": "718-528-7399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRINGFIELD SURGICAL SUPPLY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-18",
        "last_updated": "2011-08-18",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "SHATEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-528-7301",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "1249907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02982736",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.