Provider Demographics
NPI:1841293891
Name:GIBBS, ELMER RICKEY (MD)
Entity type:Individual
Prefix:DR
First Name:ELMER
Middle Name:RICKEY
Last Name:GIBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CLEVELAND ST 310
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-2854
Mailing Address - Country:US
Mailing Address - Phone:931-787-1232
Mailing Address - Fax:931-787-1228
Practice Address - Street 1:49 CLEVELAND ST 310
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-2854
Practice Address - Country:US
Practice Address - Phone:931-787-1232
Practice Address - Fax:931-787-1228
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35733208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
27-1779467OtherTAX ID
TN3382060Medicaid
TN4042486OtherTENNCARE SELECT NUMBER
TN4252798OtherBC/BS OF TN
TN3877794Medicare PIN
TN4252798OtherBC/BS OF TN
TNH68773Medicare UPIN
TN3382060Medicaid