Provider Demographics
NPI:1285739268
Name:CARE MEDICAL OF GAINESVILLE, LLC
Entity type:Organization
Organization Name:CARE MEDICAL OF GAINESVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-441-8876
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30603-1387
Mailing Address - Country:US
Mailing Address - Phone:706-354-4136
Mailing Address - Fax:706-548-7140
Practice Address - Street 1:955 INTERSTATE RIDGE DR STE D
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7051
Practice Address - Country:US
Practice Address - Phone:770-534-9944
Practice Address - Fax:770-534-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA539615923AMedicaid
GA5699050001Medicare NSC