1679578678 NPI number — GAYCO, INC.

Table of content: (NPI 1679578678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679578678 NPI number — GAYCO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GAYCO, 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:
6
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:
1679578678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 HILLCREST PKWY
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31021-3578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-272-8093
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
507 INDUSTRIAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31021-1714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-353-1579
Provider Business Practice Location Address Fax Number:
877-477-2499
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GAY
Authorized Official First Name:
BENT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
478-353-1579

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 006970 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00545993B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006970 . This is a "LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com