Provider Demographics
NPI:1003840083
Name:GATOR CUSTOM MOBILITY, INC.
Entity type:Organization
Organization Name:GATOR CUSTOM MOBILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-373-9673
Mailing Address - Street 1:501 NE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-8604
Mailing Address - Country:US
Mailing Address - Phone:352-373-9673
Mailing Address - Fax:352-271-9070
Practice Address - Street 1:501 NE 23RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-8604
Practice Address - Country:US
Practice Address - Phone:352-373-9673
Practice Address - Fax:352-271-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL047295332BC3200X
FL1543332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4044750001Medicare ID - Type Unspecified