Provider Demographics
NPI:1942290192
Name:GBT MEDICAL SUPPLY, LP
Entity Type:Organization
Organization Name:GBT MEDICAL SUPPLY, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:RENFRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-899-0605
Mailing Address - Street 1:1500 WATERS RIDGE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6011
Mailing Address - Country:US
Mailing Address - Phone:972-899-0605
Mailing Address - Fax:972-899-0615
Practice Address - Street 1:1500 WATERS RIDGE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-6011
Practice Address - Country:US
Practice Address - Phone:972-899-0605
Practice Address - Fax:972-899-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0071456332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4994310001Medicare ID - Type UnspecifiedNSC SUBMITTER ID