Provider Demographics
NPI:1578683900
Name:GRAHAM SEGO CORPORATION
Entity Type:Organization
Organization Name:GRAHAM SEGO CORPORATION
Other - Org Name:SEGOS 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 1:355 CITRUS TOWER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6501
Mailing Address - Country:US
Mailing Address - Phone:352-242-9004
Mailing Address - Fax:352-242-9006
Practice Address - Street 1:355 CITRUS TOWER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6501
Practice Address - Country:US
Practice Address - Phone:352-242-9004
Practice Address - Fax:352-242-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X, 332BP3500X, 335E00000X
FL321520332BX2000X
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
FL030871400Medicaid
FL0203020004Medicare NSC