Provider Demographics
NPI:1821645193
Name:GOLDCREST MEDICAL EQUIPMENT SERVICES, INC
Entity Type:Organization
Organization Name:GOLDCREST MEDICAL EQUIPMENT SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOTARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-442-3081
Mailing Address - Street 1:8035 E RL THRTN FWY STE 586
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-7064
Mailing Address - Country:US
Mailing Address - Phone:214-442-3081
Mailing Address - Fax:972-499-0018
Practice Address - Street 1:8035 E RL THRTN FWY STE 586
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7064
Practice Address - Country:US
Practice Address - Phone:214-442-3081
Practice Address - Fax:972-499-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition