1245629526 NPI number — P. GILL OBSTETERICS & GYNECOLOGY MEDICAL GROUP, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245629526 NPI number — P. GILL OBSTETERICS & GYNECOLOGY MEDICAL GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
P. GILL OBSTETERICS & GYNECOLOGY MEDICAL GROUP, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245629526
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1090
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LODI
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95241-1090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-334-1800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 S FAIRMONT AVE
Provider Second Line Business Practice Location Address:
STE. 230
Provider Business Practice Location Address City Name:
LODI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95240-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-334-4924
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GILL
Authorized Official First Name:
PARAMPAL
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
209-334-4924

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  243179 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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