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General NPI Number Information
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NPI Number | 1831414218
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Entity Type | Organization
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Legal Business Name | GREAT SIMOD MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 03/29/2010
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Provider Practice Location Address
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Address Line | 3400 WATT AVE SUITE 101
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City | SACRAMENTO
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State | CA
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Zip | 95821-3602
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Country | US
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Telephone | 916-977-0512
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Fax | 916-977-0505
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Provider Business Mailing Address
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Address Line | PO BOX 214913
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City | SACRAMENTO
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State | CA
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Zip | 95821-0913
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Country | US
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Telephone | 916-977-0512
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Fax | 916-977-0505
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER A. OGINNI
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Credential |
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Telephone | 916-977-0512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 52595
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License Number State | CA
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