1861615510 NPI number — DR. GREGORY CARDEN GIFFORD M.D.

Table of content: DR. GREGORY CARDEN GIFFORD M.D. (NPI 1861615510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861615510 NPI number — DR. GREGORY CARDEN GIFFORD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIFFORD
Provider First Name:
GREGORY
Provider Middle Name:
CARDEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1861615510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 SUNNYBROOK CT.
Provider Second Line Business Mailing Address:
CENTER FOR HOSPICE AND PALLIATIVE CARE, INC.
Provider Business Mailing Address City Name:
SOUTH BEND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46637-3437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-243-3100
Provider Business Mailing Address Fax Number:
574-243-3134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 SUNNYBROOK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BEND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46637-3437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-243-3100
Provider Business Practice Location Address Fax Number:
574-243-3134
Provider Enumeration Date:
04/11/2007

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: 207QH0002X , with the licence number:  01034956A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: O1O34956 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207PH0002X , with the licence number: 01034956 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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