Provider Demographics
NPI:1437100641
Name:G & O MEDICAL SERVICES CORP
Entity Type:Organization
Organization Name:G & O MEDICAL SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GICLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-487-6006
Mailing Address - Street 1:10766 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2493
Mailing Address - Country:US
Mailing Address - Phone:305-487-6006
Mailing Address - Fax:305-487-6210
Practice Address - Street 1:10766 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2493
Practice Address - Country:US
Practice Address - Phone:305-487-6006
Practice Address - Fax:305-487-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6683261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC6683OtherHEALTH CARE CLINIC LICENS
FLK9494Medicare ID - Type Unspecified