Provider Demographics
NPI:1083854244
Name:GULF SOUTH MEDICAL SUPPLY
Entity Type:Organization
Organization Name:GULF SOUTH MEDICAL SUPPLY
Other - Org Name:PSS WORLD MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, GOVERNMENT AFFAIRS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-380-4512
Mailing Address - Street 1:4345 SOUTHPOINT BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6166
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4349 DURAFORM LN
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:WI
Practice Address - Zip Code:53598-9769
Practice Address - Country:US
Practice Address - Phone:608-846-0642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1219-045332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies