Provider Demographics
NPI:1629087952
Name:GEOFFREY N GIPSON
Entity Type:Organization
Organization Name:GEOFFREY N GIPSON
Other - Org Name:VALLEY MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:GIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-895-3923
Mailing Address - Street 1:1378 LONGFELLOW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1535
Mailing Address - Country:US
Mailing Address - Phone:530-895-3923
Mailing Address - Fax:
Practice Address - Street 1:1378 LONGFELLOW AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1535
Practice Address - Country:US
Practice Address - Phone:530-895-3923
Practice Address - Fax:530-895-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0448770001Medicare NSC