Healthcare Provider Details

I. General information

NPI: 1588578116
Provider Name (Legal Business Name): GWU MEDICAL SUPPLIES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 WOOTEN WAY
BESSEMER CITY NC
28016-7817
US

IV. Provider business mailing address

1703 WOOTEN WAY
BESSEMER CITY NC
28016-7817
US

V. Phone/Fax

Practice location:
  • Phone: 704-408-4059
  • Fax: 704-408-4059
Mailing address:
  • Phone: 704-408-4059
  • Fax: 704-408-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateNULL

VIII. Authorized Official

Name: FREDERICK YEAR(S) IDEHEN
Title or Position: OWNER
Credential:
Phone: 704-408-4059