Provider Demographics
NPI:1205952694
Name:GTD MEDICAL INC.
Entity type:Organization
Organization Name:GTD MEDICAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:BOCCOF
Authorized Official - Phone:281-392-5400
Mailing Address - Street 1:830 SOUTH MASON ROAD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3863
Mailing Address - Country:US
Mailing Address - Phone:281-392-5400
Mailing Address - Fax:281-392-6096
Practice Address - Street 1:830 SOUTH MASON ROAD
Practice Address - Street 2:SUITE B1
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3863
Practice Address - Country:US
Practice Address - Phone:281-392-5400
Practice Address - Fax:281-392-6096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC17745335E00000X
TX40845332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0104473Medicaid
TX1091440001Medicare NSC