Provider Demographics
NPI:1154496743
Name:GIDMEC, LP
Entity Type:Organization
Organization Name:GIDMEC, LP
Other - Org Name:GIDDINGS MEC, LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-695-5440
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-0270
Mailing Address - Country:US
Mailing Address - Phone:979-542-9519
Mailing Address - Fax:979-542-9428
Practice Address - Street 1:721 E AUSTIN ST
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-3403
Practice Address - Country:US
Practice Address - Phone:979-542-9519
Practice Address - Fax:979-542-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0037RQOtherBCBS GROUP NUMBER
TX45D0968578OtherCLIA NUMBER
TX45D0968578OtherCLIA NUMBER