Provider Demographics
NPI:1740347053
Name:G&W DIABETIC AND MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:G&W DIABETIC AND MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-933-6460
Mailing Address - Street 1:821 N MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5524
Mailing Address - Country:US
Mailing Address - Phone:864-231-0441
Mailing Address - Fax:864-231-0941
Practice Address - Street 1:821 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5524
Practice Address - Country:US
Practice Address - Phone:864-231-0441
Practice Address - Fax:864-231-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2544Medicaid
SCDE2544Medicaid
SC=========OtherEIN