Provider Demographics
NPI:1902623846
Name:GO MEDI SUPPLY LLC
Entity type:Organization
Organization Name:GO MEDI SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GALE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-622-5247
Mailing Address - Street 1:611 SW FEDERAL HWY STE I
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2925
Mailing Address - Country:US
Mailing Address - Phone:888-918-0496
Mailing Address - Fax:
Practice Address - Street 1:611 SW FEDERAL HWY STE I
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2925
Practice Address - Country:US
Practice Address - Phone:888-918-0496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies