Provider Demographics
NPI:1679578678
Name:GAYCO, INC.
Entity Type:Organization
Organization Name:GAYCO, INC.
Other - Org Name:GAYCO HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENT
Authorized Official - Middle Name:
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-353-1579
Mailing Address - Street 1:1101 HILLCREST PKWY
Mailing Address - Street 2:STE C
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3578
Mailing Address - Country:US
Mailing Address - Phone:478-272-8093
Mailing Address - Fax:
Practice Address - Street 1:507 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-1714
Practice Address - Country:US
Practice Address - Phone:478-353-1579
Practice Address - Fax:877-477-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006970332B00000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00545993BMedicaid
GA006970OtherLICENSE
GA=========OtherTAX ID