Provider Demographics
NPI:1932294154
Name:GREAT MEDICAL SUPPLY
Entity Type:Organization
Organization Name:GREAT MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPORINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-816-0077
Mailing Address - Street 1:CALLE RODRIGUEZ IRRIZARY # 163
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-816-0077
Mailing Address - Fax:888-501-7971
Practice Address - Street 1:CALLE RODRIGUEZ IRRIZARY # 163
Practice Address - Street 2:SUITE 202
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-816-0077
Practice Address - Fax:888-501-7971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR08P1707332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0756780001Medicare ID - Type UnspecifiedMEDICARE PROVIDER