Healthcare Provider Details

I. General information

NPI: 1881691954
Provider Name (Legal Business Name): GODBEE MEDICAL DISTRIBUTORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 OFFICE PARK CIR STE 10C
MOUNTAIN BRK AL
35223-2923
US

IV. Provider business mailing address

PO BOX 530156
BIRMINGHAM AL
35253-0156
US

V. Phone/Fax

Practice location:
  • Phone: 865-806-9997
  • Fax:
Mailing address:
  • Phone: 865-806-9997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number372
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number372
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number372
License Number StateAL

VIII. Authorized Official

Name: BARON O. HUBER
Title or Position: OWNER
Credential:
Phone: 865-806-9997