1104964014 NPI number — MS. GINGER GAIL MEADE OREILLY BS

Table of content: MS. GINGER GAIL MEADE OREILLY BS (NPI 1104964014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104964014 NPI number — MS. GINGER GAIL MEADE OREILLY BS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OREILLY
Provider First Name:
GINGER
Provider Middle Name:
GAIL MEADE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEADE
Provider Other First Name:
GINGER
Provider Other Middle Name:
GAIL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104964014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9054
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37615-9054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-467-3600
Provider Business Mailing Address Fax Number:
423-467-3696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
622 POWELL AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIG STONE GAP
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-523-0682
Provider Business Practice Location Address Fax Number:
276-523-0684
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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