Organization
BLACK BEAR MEDICAL, INC.
Active
Other names
Quipt Home Medical
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY CRAWFORD (AUTHORIZED OFFICIAL)
(859) 300-6455
Entity
Organization
Contact information
Practice address
275 MARGINAL WAY, PORTLAND, ME 04101-2542
(207) 871-0008
(207) 871-0590
Mailing address
1019 TOWN DR, HIGHLAND HEIGHTS, KY 41076-9114
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
1019767
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128710000
—
ME
05
—
131150000
—
ME
Enumeration date
06/23/2005
Last updated
10/13/2025
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