Provider Demographics
NPI:1073712253
Name:SHERI C GAINES MD PA
Entity Type:Organization
Organization Name:SHERI C GAINES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:CORDING
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-597-6467
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77342-0545
Mailing Address - Country:US
Mailing Address - Phone:936-597-6467
Mailing Address - Fax:936-597-6468
Practice Address - Street 1:284 INTERSTATE 45 S STE 1
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4967
Practice Address - Country:US
Practice Address - Phone:936-438-8200
Practice Address - Fax:936-438-8527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0005QSOtherBLUE CROSS
TXDC5062OtherRAILROAD MEDICARE
TXDC5062OtherRAILROAD MEDICARE