Organization
SRC SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN E. GOULD (SENIOR VICE PRESIDENT)
(781) 707-9551
Entity
Organization
Contact information
Practice address
63 KENDRICK ST, NEEDHAM, MA 02494-2708
(781) 707-9551
(781) 707-9555
Mailing address
63 KENDRICK ST, NEEDHAM, MA 02494-2708
(781) 707-9551
(781) 707-9555
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110028722B
—
MA
Enumeration date
03/29/2007
Last updated
04/30/2010
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