Provider Demographics
NPI:1386832491
Name:TGW MEDICAL INC
Entity Type:Organization
Organization Name:TGW MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-924-9478
Mailing Address - Street 1:8537 VAN DYKE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-2374
Mailing Address - Country:US
Mailing Address - Phone:313-924-9478
Mailing Address - Fax:
Practice Address - Street 1:8537 VAN DYKE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-2374
Practice Address - Country:US
Practice Address - Phone:313-924-9478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 323P00000X
MI68010619371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N82230003Medicare PIN
MI0N82230Medicare PIN
MI0N82230002Medicare PIN