Provider Demographics
NPI:1245216134
Name:GQ MEDICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:GQ MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:OYAGHIRE
Authorized Official - Last Name:IDEHEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:407-830-0090
Mailing Address - Street 1:1250 W STATE ROAD 434
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4969
Mailing Address - Country:US
Mailing Address - Phone:407-830-0090
Mailing Address - Fax:407-830-9413
Practice Address - Street 1:1250 W STATE ROAD 434
Practice Address - Street 2:SUITE 1000
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4969
Practice Address - Country:US
Practice Address - Phone:407-830-0090
Practice Address - Fax:407-830-9413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1278332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1242500001Medicare ID - Type UnspecifiedNATIONAL SUPPLIERS NUMBER