Provider Demographics
NPI:1346749090
Name:GCXP INC
Entity Type:Organization
Organization Name:GCXP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CARMON
Authorized Official - Middle Name:L
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:888-577-6337
Mailing Address - Street 1:PO BOX 797002
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-7000
Mailing Address - Country:US
Mailing Address - Phone:888-577-6337
Mailing Address - Fax:618-624-3387
Practice Address - Street 1:1 SAINT ELIZABETH BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1099
Practice Address - Country:US
Practice Address - Phone:618-234-2120
Practice Address - Fax:904-265-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty