1740361690 NPI number — GAMMA HEALTHCARE INC

Table of content: (NPI 1740361690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740361690 NPI number — GAMMA HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAMMA HEALTHCARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740361690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1717 W MAUD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POPLAR BLUFF
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63901-4003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-727-5600
Provider Business Mailing Address Fax Number:
573-785-0753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 W MAUD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-727-5600
Provider Business Practice Location Address Fax Number:
573-785-0753
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MURPHY
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CHAIRMAN & CEO
Authorized Official Telephone Number:
573-727-5600

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01785013 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431247740LAB . This is a "PREMIER PLUS BENEFITS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 690009308 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2458112 . This is a "UHC MEDICARE COMPLETE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2458112 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 406690419 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 157554 . This is a "BLUE CROSS OF MISSOURI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 470766 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 701734105 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1740361690 . This is a "MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000014651 . This is a "ARKANSAS COMMUNITY CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200386900A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1740361690 . This is a "GHP/ COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1740361690 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 113580 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 159997709 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18127 . This is a "BLUE CROSS BLUE SHEILD OF ARKANSAS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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