Provider Demographics
NPI:1215058086
Name:CUSTOM SPECIALTY PRODUCTS, LTD.
Entity type:Organization
Organization Name:CUSTOM SPECIALTY PRODUCTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRES.
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-942-1773
Mailing Address - Street 1:490 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-4808
Mailing Address - Country:US
Mailing Address - Phone:401-942-1773
Mailing Address - Fax:401-944-5571
Practice Address - Street 1:490 UNION AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-4808
Practice Address - Country:US
Practice Address - Phone:401-942-1773
Practice Address - Fax:401-944-5571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI15710171WH0202X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICS29152OtherDME PROVIDER