Basic Information
| Provider Information | |||||||||
| NPI: | 1205952694 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GTD MEDICAL INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ADVANCED MEDICAL SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 830 SOUTH MASON ROAD | ||||||||
| Address2: | SUITE B1 | ||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774503863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813925400 | ||||||||
| FaxNumber: | 2813926096 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 SOUTH MASON ROAD | ||||||||
| Address2: | SUITE B1 | ||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774503863 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813925400 | ||||||||
| FaxNumber: | 2813926096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 06/28/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MORRISON | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | RUSSELL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 2813925400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | BOCCOF | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335E00000X | C17745 | TX | N | Suppliers | Prosthetic/Orthotic Supplier | 332B00000X | 40845 | TX | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 0104473 | 05 | TX | MEDICAID |