Provider Demographics
NPI:1497786594
Name:NABIL GUIRGUIS
Entity Type:Organization
Organization Name:NABIL GUIRGUIS
Other - Org Name:THE KIDNEY CENTER GENTLE DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD EXECUTIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GUIRGUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-842-6001
Mailing Address - Street 1:166 THOMPSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330
Mailing Address - Country:US
Mailing Address - Phone:304-842-6001
Mailing Address - Fax:304-842-6111
Practice Address - Street 1:166 THOMPSON DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:304-842-6001
Practice Address - Fax:304-842-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000048Medicaid
WV3810000048Medicaid
WV9345451Medicare PIN