Provider Demographics
NPI:1760493654
Name:TINA G. GAUNT, MD, PLLC
Entity Type:Organization
Organization Name:TINA G. GAUNT, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:GAUNT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-437-5425
Mailing Address - Street 1:151 N EAGLE CREEK DR
Mailing Address - Street 2:STE 12
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1889
Mailing Address - Country:US
Mailing Address - Phone:606-437-5425
Mailing Address - Fax:606-437-5427
Practice Address - Street 1:1098 S MAYO TRL
Practice Address - Street 2:STE 303
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1546
Practice Address - Country:US
Practice Address - Phone:606-437-5425
Practice Address - Fax:606-437-5427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64-047434Medicaid
KY64-047434Medicaid
KYH62018Medicare UPIN