MEDICARE: GILLIGAN AND FERNEMAN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1235381682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILLIGAN AND FERNEMAN LLC

Provider Business Mailing Address
First Line	:	PO BOX 9166
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32417-9166
Country	:	US
Telephone Number	:	850-588-8695
Fax Number	:	850-588-8696

Provider Business Practice Location Address
First Line	:	7328 THOMAS DR
Second Line	:	SUITE B
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-7500
Country	:	US
Telephone Number	:	850-588-8695
Fax Number	:	850-588-8696

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MR. MICHAEL STIG FERNEMAN
Credential	:
Telephone Number	:	850-532-3640

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	10/16/2008

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