Provider Demographics
| NPI: | 1114948288 |
|---|---|
| Name: | GILBERT BARBEE MOORE & MCILVOY PSC |
| Entity Type: | Organization |
| Organization Name: | GILBERT BARBEE MOORE & MCILVOY PSC |
| Other - Org Name: | GRAVES-GILBERT CLINIC |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | ADMINISTRATOR |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | STEVEN |
| Authorized Official - Middle Name: | K |
| Authorized Official - Last Name: | SINCLAIR |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 270-781-5111 |
| Mailing Address - Street 1: | 201 PARK ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BOWLING GREEN |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 42101-1742 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 270-781-5111 |
| Mailing Address - Fax: | 270-780-0478 |
| Practice Address - Street 1: | 201 PARK ST |
| Practice Address - Street 2: | |
| Practice Address - City: | BOWLING GREEN |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 42101-1759 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 270-781-5111 |
| Practice Address - Fax: | 270-780-0479 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-07-22 |
| Last Update Date: | 2022-07-01 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 103G00000X, 152W00000X, 174400000X, 208M00000X, 225100000X, 231H00000X, 332900000X, 332B00000X, 363A00000X, 363L00000X | ||
| KY | 207T00000X, 207X00000X, 225X00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty | |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
| No | 332900000X | Suppliers | Non-Pharmacy Dispensing Site | Group - Multi-Specialty | |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KY | 0584320001 | Other | DME MEDICARE |
| KY | CC0284 | Other | MEDICARE RAILROAD |
| KY | 65908766 | Medicaid | |
| KY | CC0284 | Other | MEDICARE RAILROAD |
| KY | CC0284 | Other | MEDICARE RAILROAD |
| 5353 | Medicare PIN | ||
| 6411 | Medicare PIN | ||
| KY | 0584320001 | Other | DME MEDICARE |
| 8183 | Medicare PIN | ||
| 5352 | Medicare PIN | ||
| KY | 65908766 | Medicaid | |
| 7540 | Medicare PIN | ||
| 5346 | Medicare PIN | ||
| 5351 | Medicare PIN | ||
| 5345 | Medicare PIN | ||
| 4374 | Medicare PIN |
