Provider Demographics
NPI:1417945742
Name:GTMO MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:GTMO MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROMMEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-856-3005
Mailing Address - Street 1:CALLE PROLONGACION 25 DE JULIO
Mailing Address - Street 2:# 25
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3053
Mailing Address - Country:US
Mailing Address - Phone:787-856-3005
Mailing Address - Fax:787-267-8298
Practice Address - Street 1:CALLE PROLONGACION 25 DE JULIO
Practice Address - Street 2:# 25
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3053
Practice Address - Country:US
Practice Address - Phone:787-856-3005
Practice Address - Fax:787-267-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4597330001Medicare ID - Type Unspecified