Provider Demographics
NPI:1730831827
Name:GIFTED HEARTS MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:GIFTED HEARTS MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUSU-BOAKYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-715-9299
Mailing Address - Street 1:1012 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5822
Mailing Address - Country:US
Mailing Address - Phone:830-715-9299
Mailing Address - Fax:830-715-9302
Practice Address - Street 1:1012 E COURT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5822
Practice Address - Country:US
Practice Address - Phone:830-715-9299
Practice Address - Fax:830-715-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies