Provider Demographics
NPI:1194381368
Name:GOSSETT GLOBAL HEALTH SOLUTIONS PC
Entity Type:Organization
Organization Name:GOSSETT GLOBAL HEALTH SOLUTIONS PC
Other - Org Name:GOSSETT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-351-8040
Mailing Address - Street 1:1717 W KIRBY AVE # 246
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-5507
Mailing Address - Country:US
Mailing Address - Phone:217-351-8040
Mailing Address - Fax:
Practice Address - Street 1:206 BURWASH AVE
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-9510
Practice Address - Country:US
Practice Address - Phone:217-351-8040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty