Provider Demographics
NPI:1003854589
Name:GO- MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:GO- MEDICAL SERVICES LLC
Other - Org Name:GO MEDICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-358-8200
Mailing Address - Street 1:P O BOX 1923
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-0923
Mailing Address - Country:US
Mailing Address - Phone:816-358-8200
Mailing Address - Fax:816-817-0028
Practice Address - Street 1:10215 E US HIGHWAY 40
Practice Address - Street 2:STE D
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6147
Practice Address - Country:US
Practice Address - Phone:816-358-8200
Practice Address - Fax:816-817-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00675817332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO35991012OtherBCBS OF KANSAS CITY
MO626221907Medicaid
KS200362040AMedicaid
MO35991012OtherBCBS OF KANSAS CITY