1477595254 NPI number — GDME INC

Table of content: (NPI 1477595254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477595254 NPI number — GDME INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GDME INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GLOBE DRUG AND MEDICAL EQUIPMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477595254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
304 N POKEGAMA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-326-2635
Provider Business Mailing Address Fax Number:
218-326-2526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 N POKEGAMA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-326-2635
Provider Business Practice Location Address Fax Number:
218-326-2526
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRANDT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
RPH/PRESIDENT
Authorized Official Telephone Number:
218-360-1112

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 264322 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2144052 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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