Organization
BLK INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRIDGET L KITTREDGE L.D.O (PRESIDENT, MGR)
(617) 773-7426
Entity
Organization
Contact information
Practice address
470 SOUTHERN ARTERY, QUINCY, MA 02169-4614
(617) 773-7426
(617) 770-9453
Mailing address
470 SOUTHERN ARTERY, QUINCY, MA 02169-4614
(617) 773-7426
(617) 770-9453
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
2083
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1529072
MASSHEALTH
MA
01
—
412958
BLUE CROSS BLUE SHIELD
MA
01
—
MA2083
EYEMED
MD
Enumeration date
12/19/2007
Last updated
12/19/2007
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