1841473337 NPI number — GIBSON'S TRANSPORTATION LLC

Table of content: (NPI 1841473337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841473337 NPI number — GIBSON'S TRANSPORTATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GIBSON'S TRANSPORTATION 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:
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:
1841473337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1341 BUFFALO TRAIL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-312-6222
Provider Business Mailing Address Fax Number:
866-587-5081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1341 BUFFALO TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37814-5217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-587-8497
Provider Business Practice Location Address Fax Number:
423-587-0858
Provider Enumeration Date:
12/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SOLE MEMBER
Authorized Official Telephone Number:
423-312-6222

Provider Taxonomy Codes

  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: T000123 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".