Provider Demographics
NPI:1912611427
Name:GOOD WILL MED SUPPLIES LLC
Entity Type:Organization
Organization Name:GOOD WILL MED SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAGAB
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELMGED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-513-0731
Mailing Address - Street 1:6105 MEMORIAL HWY STE A14
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4505
Mailing Address - Country:US
Mailing Address - Phone:813-513-0731
Mailing Address - Fax:
Practice Address - Street 1:6105 MEMORIAL HWY STE A14
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4505
Practice Address - Country:US
Practice Address - Phone:813-513-0731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies