Provider Demographics
NPI:1740430677
Name:DR GILS IMMEDIATE CARE
Entity Type:Organization
Organization Name:DR GILS IMMEDIATE CARE
Other - Org Name:OZARK EMERGENCY MEDICINE ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-869-8000
Mailing Address - Street 1:3000 E DIVISION
Mailing Address - Street 2:SUITE E
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802
Mailing Address - Country:US
Mailing Address - Phone:417-869-8000
Mailing Address - Fax:417-869-8005
Practice Address - Street 1:3000 E DIVISION
Practice Address - Street 2:SUITE E
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802
Practice Address - Country:US
Practice Address - Phone:417-869-8000
Practice Address - Fax:417-869-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD30270Medicare UPIN