Provider Demographics
NPI:1265428122
Name:BOSTON ARTIFICIAL LIMB COMPANY, INC.
Entity type:Organization
Organization Name:BOSTON ARTIFICIAL LIMB COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:781-272-3132
Mailing Address - Street 1:44 MIDDLESEX TPKE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4912
Mailing Address - Country:US
Mailing Address - Phone:781-272-3132
Mailing Address - Fax:781-272-5605
Practice Address - Street 1:44 MIDDLESEX TPKE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4912
Practice Address - Country:US
Practice Address - Phone:781-272-3132
Practice Address - Fax:781-272-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1500589Medicaid
MABO361954OtherBCBS OF MA
MA801166OtherTUFTS HC OF MA
MA602259OtherHARVARD PILGRIM HC OF MA
MA0141470001Medicare NSC