MEDICARE: GOOD SHEPHERD MEDICAL SUPPLIES 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	1313135	FL

General Provider Information

NPI Number	:	1972690808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD MEDICAL SUPPLIES INC

Provider Business Mailing Address
First Line	:	7416 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-4812
Country	:	US
Telephone Number	:	561-533-0858
Fax Number	:

Provider Business Practice Location Address
First Line	:	7416 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-4812
Country	:	US
Telephone Number	:	561-533-0858
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUIS OLIVA
Credential	:
Telephone Number	:	561-533-0858

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	08/22/2020

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