Provider Demographics
NPI:1639217631
Name:GATES COUNTY MEDICAL CENTER LLC
Entity type:Organization
Organization Name:GATES COUNTY MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-357-1226
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27938-0297
Mailing Address - Country:US
Mailing Address - Phone:252-357-1226
Mailing Address - Fax:252-357-1236
Practice Address - Street 1:501 MAIN ST
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27938-9424
Practice Address - Country:US
Practice Address - Phone:252-357-1226
Practice Address - Fax:252-357-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care