Provider Demographics
NPI:1194951848
Name:GOODFAITH MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:GOODFAITH MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MINIRU
Authorized Official - Middle Name:OMOTAYO
Authorized Official - Last Name:ALAWIYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-561-1224
Mailing Address - Street 1:6500 BROOKLYN BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1754
Mailing Address - Country:US
Mailing Address - Phone:763-561-1224
Mailing Address - Fax:763-503-9451
Practice Address - Street 1:6500 BROOKLYN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1754
Practice Address - Country:US
Practice Address - Phone:763-561-1224
Practice Address - Fax:763-503-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies