Provider Demographics
NPI:1235381682
Name:GILLIGAN AND FERNEMAN LLC
Entity Type:Organization
Organization Name:GILLIGAN AND FERNEMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STIG
Authorized Official - Last Name:FERNEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-532-3640
Mailing Address - Street 1:PO BOX 9166
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32417-9166
Mailing Address - Country:US
Mailing Address - Phone:850-588-8695
Mailing Address - Fax:850-588-8696
Practice Address - Street 1:7328 THOMAS DR
Practice Address - Street 2:SUITE B
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-7500
Practice Address - Country:US
Practice Address - Phone:850-588-8695
Practice Address - Fax:850-588-8696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment