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General NPI Number Information
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NPI Number | 1861652521
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Entity Type | Organization
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Legal Business Name | GO MEDICAL
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Dates
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Enumeration Date | 06/16/2008
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 602 BROOKFIELD LOOP
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City | LAKE MARY
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State | FL
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Zip | 32746-3718
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Country | US
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Telephone | 407-496-3222
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Fax | 407-324-9046
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Provider Business Mailing Address
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Address Line | PO BOX 950936
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City | LAKE MARY
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State | FL
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Zip | 32795-0936
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Country | US
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Telephone | 407-496-3222
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Fax | 407-324-9046
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TIMOTHY HARPER PENDRY
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Credential | BD. MS.
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Telephone | 407-324-9046
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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 | OLHS2007082302407
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License Number State | FL
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