Provider Demographics
NPI:1023049947
Name:GABBIE MEDICAL CLINIC PA
Entity type:Organization
Organization Name:GABBIE MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:O
Authorized Official - Last Name:GABBIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-614-8337
Mailing Address - Street 1:401 EAST ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-6507
Mailing Address - Country:US
Mailing Address - Phone:903-614-8337
Mailing Address - Fax:903-614-5251
Practice Address - Street 1:401 EAST ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-6507
Practice Address - Country:US
Practice Address - Phone:903-614-8337
Practice Address - Fax:903-614-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165764501Medicaid
AR9R059OtherBLUE CROSS BLUE SHIELD
AR155508002Medicaid
TX0021LMOtherBLUE CROSS BLUE SHIELD
TX5099470001OtherDME
TX5099470001OtherDME
TX0021LMOtherBLUE CROSS BLUE SHIELD
TXDB9903Medicare ID - Type UnspecifiedRAILROAD