Provider Demographics
NPI:1821392333
Name:GILBERT, JIM
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14615 N 31ST LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4809
Mailing Address - Country:US
Mailing Address - Phone:928-533-7221
Mailing Address - Fax:888-503-3633
Practice Address - Street 1:5760 S ELAND DR
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9293
Practice Address - Country:US
Practice Address - Phone:928-533-7221
Practice Address - Fax:888-503-3633
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20634211343900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)