Provider Demographics
NPI:1851324511
Name:GOLDSTAR MEDICAL & HOSPITAL SUPPLY, INC
Entity Type:Organization
Organization Name:GOLDSTAR MEDICAL & HOSPITAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-231-7177
Mailing Address - Street 1:7911 NW 72ND AVE
Mailing Address - Street 2:220A
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2227
Mailing Address - Country:US
Mailing Address - Phone:305-231-7177
Mailing Address - Fax:305-402-3836
Practice Address - Street 1:7911 NW 72ND AVE
Practice Address - Street 2:220A
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-2227
Practice Address - Country:US
Practice Address - Phone:305-231-7177
Practice Address - Fax:305-402-3836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1844332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4615880001Medicare ID - Type UnspecifiedPROVIDER NUMBER