Provider Demographics
NPI:1417100355
Name:G & C DIABETIC SUPPLY
Entity Type:Organization
Organization Name:G & C DIABETIC SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:N
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-838-4674
Mailing Address - Street 1:1300 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3659
Mailing Address - Country:US
Mailing Address - Phone:304-367-1241
Mailing Address - Fax:304-363-6758
Practice Address - Street 1:1300 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3659
Practice Address - Country:US
Practice Address - Phone:304-367-1241
Practice Address - Fax:304-363-6758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies