Provider Demographics
NPI:1932449451
Name:GACEK EAR AND SINUS CENTER LLC
Entity Type:Organization
Organization Name:GACEK EAR AND SINUS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:GACEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-340-7970
Mailing Address - Street 1:4721 MORRISON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3350
Mailing Address - Country:US
Mailing Address - Phone:251-340-6947
Mailing Address - Fax:251-460-5457
Practice Address - Street 1:720 HILLCREST RD STE A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3904
Practice Address - Country:US
Practice Address - Phone:251-340-7970
Practice Address - Fax:251-340-7971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0002170207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL147898Medicaid
AL102G703401Medicare PIN