Provider Demographics
NPI:1215010459
Name:EDDIE G GAINES MD PC
Entity Type:Organization
Organization Name:EDDIE G GAINES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-882-1881
Mailing Address - Street 1:2227 DRAKE AVE SW
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-5199
Mailing Address - Country:US
Mailing Address - Phone:256-882-1881
Mailing Address - Fax:256-882-3691
Practice Address - Street 1:2227 DRAKE AVE SW
Practice Address - Street 2:SUITE 6
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-5199
Practice Address - Country:US
Practice Address - Phone:256-882-1881
Practice Address - Fax:256-882-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK106Medicare PIN