Provider Demographics
NPI:1174829519
Name:GIBSON HEALTHCARE ENTERPRISES INC
Entity Type:Organization
Organization Name:GIBSON HEALTHCARE ENTERPRISES INC
Other - Org Name:PREMIER URGENT CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:XUNDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-580-1036
Mailing Address - Street 1:2400 W SAMPLE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3062
Mailing Address - Country:US
Mailing Address - Phone:954-580-1036
Mailing Address - Fax:954-580-1099
Practice Address - Street 1:2400 W SAMPLE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33073-3062
Practice Address - Country:US
Practice Address - Phone:954-580-1036
Practice Address - Fax:954-580-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care