Healthcare Provider Details

I. General information

NPI: 1649365669
Provider Name (Legal Business Name): GULF MEDICAL SERVICES. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 RACETRACK RD NE
FORT WALTON BEACH FL
32547-2546
US

IV. Provider business mailing address

320 RACETRACK RD NE
FORT WALTON BEACH FL
32547-2546
US

V. Phone/Fax

Practice location:
  • Phone: 850-314-9955
  • Fax: 850-314-9927
Mailing address:
  • Phone: 850-314-9955
  • Fax: 850-314-9927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1593
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberHME 1593
License Number StateFL

VIII. Authorized Official

Name: MR. KENNETH R STEBER
Title or Position: PRESIDENT
Credential:
Phone: 850-438-7600