Provider Demographics
NPI:1356303473
Name:GENTILE HEALTHCARE , P.C.
Entity Type:Organization
Organization Name:GENTILE HEALTHCARE , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:219-865-9160
Mailing Address - Street 1:1001 MAIN ST
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1234
Mailing Address - Country:US
Mailing Address - Phone:219-865-9160
Mailing Address - Fax:219-865-9251
Practice Address - Street 1:1001 MAIN ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1234
Practice Address - Country:US
Practice Address - Phone:219-865-9160
Practice Address - Fax:219-865-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082524Medicaid
IN100468800AMedicaid
INF21843Medicare UPIN
IN217610BMedicare ID - Type Unspecified
IN217610CMedicare ID - Type Unspecified
INH10660Medicare UPIN