Provider Demographics
NPI:1114808474
Name:GINA CROSSWHITE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:GINA CROSSWHITE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CROSSWHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-810-1069
Mailing Address - Street 1:1425 SOTO ST
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-5133
Mailing Address - Country:US
Mailing Address - Phone:678-810-1069
Mailing Address - Fax:
Practice Address - Street 1:1425 SOTO ST
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5133
Practice Address - Country:US
Practice Address - Phone:678-810-1069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies