Provider Demographics
NPI:1467557991
Name:GARY C HILL MD INC
Entity Type:Organization
Organization Name:GARY C HILL MD INC
Other - Org Name:GARY C HILL MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-359-9669
Mailing Address - Street 1:200 N BRYANT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6273
Mailing Address - Country:US
Mailing Address - Phone:405-359-9669
Mailing Address - Fax:405-359-6546
Practice Address - Street 1:200 N BRYANT AVE STE 100
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6273
Practice Address - Country:US
Practice Address - Phone:405-359-9669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11505174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1568428696OtherMEDICARE INDIVIDUAL NPI
OKOKA103535OtherMEDICARE INDIVIDUAL PTAN
OK100123190A*21Medicaid
OK1467557991OtherMEDICARE GROUP NPI
OKOKA103534OtherMEDICARE GROUP PTAN
OK100123190A*21Medicaid
OK446489031Medicare ID - Type Unspecified
OK1467557991OtherMEDICARE GROUP NPI