Provider Demographics
NPI:1457474157
Name:GRAHAM-SEGO CORPORATION
Entity Type:Organization
Organization Name:GRAHAM-SEGO CORPORATION
Other - Org Name:SEGO'S HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:E.
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:SEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-268-0179
Mailing Address - Street 1:1317 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3312
Mailing Address - Country:US
Mailing Address - Phone:321-268-0179
Mailing Address - Fax:321-264-2780
Practice Address - Street 1:1317 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3312
Practice Address - Country:US
Practice Address - Phone:321-268-0179
Practice Address - Fax:321-264-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X, 332BP3500X, 335E00000X
FL32600332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103842796OtherMEDWAIVER
FL103842701Medicaid
FL0203020003Medicare NSC