Provider Demographics
NPI:1114994654
Name:G & J MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:G & J MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:OBINNA
Authorized Official - Last Name:OJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-683-6223
Mailing Address - Street 1:929 NEW LEICESTER HWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1056
Mailing Address - Country:US
Mailing Address - Phone:828-683-6223
Mailing Address - Fax:828-683-6243
Practice Address - Street 1:929 NEW LEICESTER HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1056
Practice Address - Country:US
Practice Address - Phone:828-683-6223
Practice Address - Fax:828-683-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5559400001332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4582386Medicaid
NC7704387Medicaid
SCDE2735Medicaid
NC7704387Medicaid