Provider Demographics
NPI:1962574525
Name:GEORGIA MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:GEORGIA MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOLBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:PELAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-768-1499
Mailing Address - Street 1:3450 W 84TH ST
Mailing Address - Street 2:102-C
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4924
Mailing Address - Country:US
Mailing Address - Phone:786-768-1499
Mailing Address - Fax:305-477-6518
Practice Address - Street 1:3450 W 84TH ST
Practice Address - Street 2:102-C
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4924
Practice Address - Country:US
Practice Address - Phone:786-768-1499
Practice Address - Fax:305-477-6518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2057698887OtherEIN