Provider Demographics
NPI:1588971097
Name:CITIZEN MED
Entity type:Organization
Organization Name:CITIZEN MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HRADECKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-433-4199
Mailing Address - Street 1:816 ELM ST # 226
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2105
Mailing Address - Country:US
Mailing Address - Phone:866-433-4199
Mailing Address - Fax:603-899-9977
Practice Address - Street 1:816 ELM ST # 226
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2105
Practice Address - Country:US
Practice Address - Phone:866-433-4199
Practice Address - Fax:603-899-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies