# GREAT SIMOD MEDICAL SUPPLY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831414218
- **Authorized official:** PETER A. OGINNI (PRESIDENT)
- **Authorized official phone:** (916) 977-0512

## Contact information

- **Practice address:** 3400 WATT AVE, SUITE 101, SACRAMENTO, CA 95821-3602
- **Practice address phone:** (916) 977-0512
- **Practice address fax:** (916) 977-0505
- **Mailing address:** PO BOX 214913, SACRAMENTO, CA 95821-0913
- **Mailing address phone:** (916) 977-0512
- **Mailing address fax:** (916) 977-0505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 52595 | CA | Yes |

## Other

- **Enumeration date:** 03/29/2010
- **Last updated:** 03/29/2010