Provider Demographics
NPI:1205074093
Name:ALLAN C GOCIO MD NEUROSURGICAL CARE, LLC
Entity type:Organization
Organization Name:ALLAN C GOCIO MD NEUROSURGICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOCIO
Authorized Official - Suffix:
Authorized Official - Credentials:LPN,CPC
Authorized Official - Phone:618-997-1200
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-0430
Mailing Address - Country:US
Mailing Address - Phone:618-997-1200
Mailing Address - Fax:618-997-1212
Practice Address - Street 1:3331 W DEYOUNG ST
Practice Address - Street 2:STE 308
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5896
Practice Address - Country:US
Practice Address - Phone:618-997-1200
Practice Address - Fax:618-997-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-113252207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL432921318Medicaid
ILIL1627Medicare PIN
B90222Medicare UPIN