Provider Demographics
NPI: | 1619571320 |
---|---|
Name: | GILBERT HEALTH CENTER LLC |
Entity Type: | Organization |
Organization Name: | GILBERT HEALTH CENTER LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | GREG |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | VOGEL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 480-497-2900 |
Mailing Address - Street 1: | 754 S VAL VISTA DR STE 104 |
Mailing Address - Street 2: | |
Mailing Address - City: | GILBERT |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85296-3139 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-497-2900 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 754 S VAL VISTA DR STE 104 |
Practice Address - Street 2: | |
Practice Address - City: | GILBERT |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85296-3139 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-497-2900 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-11-23 |
Last Update Date: | 2021-08-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
No | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty |