Provider Demographics
NPI:1114117579
Name:GO MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:GO MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:O
Authorized Official - Last Name:OJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-918-4130
Mailing Address - Street 1:3467 US HIGHWAY 601 SOUTH
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025
Mailing Address - Country:US
Mailing Address - Phone:704-563-1104
Mailing Address - Fax:704-563-1105
Practice Address - Street 1:3467 US HIGHWAY 601 S
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-0490
Practice Address - Country:US
Practice Address - Phone:704-918-4130
Practice Address - Fax:980-781-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5965100001Medicare NSC