Healthcare Provider Details

I. General information

NPI: 1033659727
Provider Name (Legal Business Name): GAINESVILLE GROUP SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 SW 76TH ST STE 140
GAINESVILLE FL
32608-0345
US

IV. Provider business mailing address

2440 SW 76TH ST STE 140
GAINESVILLE FL
32608-0345
US

V. Phone/Fax

Practice location:
  • Phone: 352-284-2879
  • Fax:
Mailing address:
  • Phone: 352-284-2879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LISETE M PEREZ
Title or Position: PRESIDENT
Credential:
Phone: 352-284-2879