Provider Demographics
NPI:1023203692
Name:POWER TAKE OFF ENTERPRISES, INC.
Entity Type:Organization
Organization Name:POWER TAKE OFF ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:R.
Authorized Official - Middle Name:B
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:229-624-2394
Mailing Address - Street 1:1044 SCENIC RTE
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-6214
Mailing Address - Country:US
Mailing Address - Phone:229-624-2394
Mailing Address - Fax:229-624-2121
Practice Address - Street 1:402 EAST COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:PINEVIEW
Practice Address - State:GA
Practice Address - Zip Code:31071
Practice Address - Country:US
Practice Address - Phone:229-624-2394
Practice Address - Fax:229-624-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0165300001Medicare NSC