=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316110182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GSK GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2008
-----------------------------------------------------
Last Update Date | 04/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2087 GRAND CANAL BLVD SUITE 10
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95207-6651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-478-0691
-----------------------------------------------------
Fax | 209-478-0919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2087 GRAND CANAL BLVD SUITE 9B
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95207-6651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-478-0691
-----------------------------------------------------
Fax | 209-478-0919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MISS GLADYS SAMSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 209-478-0691
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------