Provider Demographics
NPI:1811975725
Name:NORTH CENTRAL MEDICAL CORPORATION INC
Entity type:Organization
Organization Name:NORTH CENTRAL MEDICAL CORPORATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:B
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:352-373-9656
Mailing Address - Street 1:PO BOX 142098
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614-2098
Mailing Address - Country:US
Mailing Address - Phone:352-373-9656
Mailing Address - Fax:352-374-4136
Practice Address - Street 1:4001 NEWBERRY RD
Practice Address - Street 2:STE A2
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2358
Practice Address - Country:US
Practice Address - Phone:352-373-9656
Practice Address - Fax:352-374-4136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009930935Medicaid
LA1164348Medicaid
NC7703365Medicaid
SCDM1139OtherSOUTH CAROLINA MEDICAID P
GA606429698AMedicaid
VA010070554OtherVIRGINIA MEDICAL ASSISTAN
MS0440757Medicaid
LA1164348Medicaid