MEDICARE: GOODWILL MEDICAL SUPPLIES LLC

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1619801552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOODWILL MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	24027 BARNETT OVERLOOK
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-1038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24027 BARNETT OVERLOOK
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-1038
Country	:	US
Telephone Number	:	432-224-2624
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALEX JOHN
Credential	:
Telephone Number	:	432-224-2624

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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