Healthcare Provider Details

I. General information

NPI: 1033136957
Provider Name (Legal Business Name): GSTS DESIGNS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 BALD HILL LOOP
MADISON NC
27025-7627
US

IV. Provider business mailing address

2075 BALD HILL LOOP
MADISON NC
27025-7627
US

V. Phone/Fax

Practice location:
  • Phone: 336-427-8765
  • Fax: 336-427-6969
Mailing address:
  • Phone: 336-427-8765
  • Fax: 336-427-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00674
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier009110569
Identifier TypeMEDICAID
Identifier StateVA
Identifier Issuer

VIII. Authorized Official

Name: GLEN S. JOHNSON
Title or Position: ASST. MANAGER
Credential:
Phone: 336-427-8765