Provider Demographics
NPI:1134120462
Name:GALAXY MEDICAL INC
Entity Type:Organization
Organization Name:GALAXY MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-731-8977
Mailing Address - Street 1:4700 W PROSPECT RD
Mailing Address - Street 2:SUITE 107 GALAXY MEDICAL
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-8001
Mailing Address - Country:US
Mailing Address - Phone:954-731-8977
Mailing Address - Fax:954-731-8722
Practice Address - Street 1:4700 W PROSPECT RD
Practice Address - Street 2:SUITE 107 GALAXY MEDICAL
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-8001
Practice Address - Country:US
Practice Address - Phone:954-731-8977
Practice Address - Fax:954-731-8722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL220 AHCA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0428670001Medicare ID - Type Unspecified