Provider Demographics
NPI:1447776331
Name:GADDY ENTERPRISES, INC
Entity Type:Organization
Organization Name:GADDY ENTERPRISES, INC
Other - Org Name:GADDY'S MEDICAL EQUIPMENT & SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-590-4464
Mailing Address - Street 1:PO BOX 1035
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-1035
Mailing Address - Country:US
Mailing Address - Phone:936-590-4464
Mailing Address - Fax:936-590-4468
Practice Address - Street 1:3500 NORTH ST STE 1A
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2485
Practice Address - Country:US
Practice Address - Phone:936-569-8585
Practice Address - Fax:936-569-8525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GADDY ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-22
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies