1942287305 NPI number — GERALD GORDON, MD, FACP, LLC

Table of content: (NPI 1942287305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942287305 NPI number — GERALD GORDON, MD, FACP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERALD GORDON, MD, FACP, LLC
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:
INTERNAL MEDICINE ASSOCIATES OF AIKEN
Provider Other Organization Name Type Code:
3
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:
1942287305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5238
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29804-5238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-649-5300
Provider Business Mailing Address Fax Number:
803-649-0056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 SUMMERWOOD WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29803-7704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-649-5300
Provider Business Practice Location Address Fax Number:
803-649-0056
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
803-649-5300

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  17475 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 21255 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 0689 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: GP2024 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CG6336 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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