Provider Demographics
NPI:1154512978
Name:ALFRED GILGORE MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:ALFRED GILGORE MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:913-888-1133
Mailing Address - Street 1:9421 PFLUMM RD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3307
Mailing Address - Country:US
Mailing Address - Phone:913-888-1133
Mailing Address - Fax:
Practice Address - Street 1:9421 PFLUMM RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3307
Practice Address - Country:US
Practice Address - Phone:913-888-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15547261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5370000AOtherMEDICARE GROUP NUMBER
KS03952017OtherBCBSKC