Provider Demographics
NPI:1598201196
Name:P A CORPORATE ENTERPRISES LLP
Entity Type:Organization
Organization Name:P A CORPORATE ENTERPRISES LLP
Other - Org Name:SOUTH GIBSON FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JEFF
Authorized Official - Last Name:WILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:713-462-0000
Mailing Address - Street 1:589 HIGHWAY 45 BYP S
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-9633
Mailing Address - Country:US
Mailing Address - Phone:713-462-0000
Mailing Address - Fax:
Practice Address - Street 1:589 HIGHWAY 45 BYP S
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:TN
Practice Address - Zip Code:38355-9633
Practice Address - Country:US
Practice Address - Phone:713-462-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty