Healthcare Provider Details

I. General information

NPI: 1982183026
Provider Name (Legal Business Name): GULF MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CABLE DR
LAFAYETTE LA
70506-2201
US

IV. Provider business mailing address

102 CABLE DR
LAFAYETTE LA
70506-2201
US

V. Phone/Fax

Practice location:
  • Phone: 844-877-7548
  • Fax: 337-205-8631
Mailing address:
  • Phone: 844-877-7548
  • Fax: 337-205-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN WALSH CRISMAN
Title or Position: MANAGER
Credential:
Phone: 844-877-7548