Provider Demographics
NPI:1760747141
Name:CGG INTERNAL MEDICINE
Entity Type:Organization
Organization Name:CGG INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERTON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:859-264-8005
Mailing Address - Street 1:120 N EAGLE CREEK DR
Mailing Address - Street 2:SUITE321
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1827
Mailing Address - Country:US
Mailing Address - Phone:859-264-8005
Mailing Address - Fax:859-264-8026
Practice Address - Street 1:120 N EAGLE CREEK DR
Practice Address - Street 2:SUITE321
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1827
Practice Address - Country:US
Practice Address - Phone:859-264-8005
Practice Address - Fax:859-264-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty