MEDICARE: GADDY ENTERPRISES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	1001013	TX

General Provider Information

NPI Number	:	1578983292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GADDY ENTERPRISES, INC

Provider Business Mailing Address
First Line	:	PO BOX 1035
Second Line	:
City	:	CENTER
State	:	TX
Zip	:	75935-1035
Country	:	US
Telephone Number	:	936-590-4464
Fax Number	:	936-590-4468

Provider Business Practice Location Address
First Line	:	3500 NORTH ST
Second Line	:	SUITE #1-A
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2472
Country	:	US
Telephone Number	:	936-569-8585
Fax Number	:	936-569-8525

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMANDA M BUSH
Credential	:
Telephone Number	:	936-590-4464

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	10/24/2023

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