Provider Demographics
NPI:1497909501
Name:ANDREW C GIN, PLLC
Entity Type:Organization
Organization Name:ANDREW C GIN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:GIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-682-9955
Mailing Address - Street 1:1211 N SHARTEL AVE
Mailing Address - Street 2:STE 600
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2400
Mailing Address - Country:US
Mailing Address - Phone:405-682-9955
Mailing Address - Fax:405-682-9979
Practice Address - Street 1:1211 N SHARTEL AVE
Practice Address - Street 2:STE 600
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2400
Practice Address - Country:US
Practice Address - Phone:405-682-9955
Practice Address - Fax:405-682-9979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11482261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1336110717OtherNPI INDIVIDUAL
OK100252780BMedicaid
OKP00281427OtherRR MEDICARE
OKP00281427OtherRR MEDICARE