MEDICARE: GINGERICH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1811585144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GINGERICH LLC

Provider Business Mailing Address
First Line	:	210 EDGEWOOD DR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4240
Country	:	US
Telephone Number	:	937-623-1975
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 HAMPTON AVE STE 11B
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-1044
Country	:	US
Telephone Number	:	937-623-1975
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CODY GINGERICH
Credential	:
Telephone Number	:	937-623-1975

Provider Enumeration Date	:	01/03/2021
Last Update Date	:	12/19/2024

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Directions to “GINGERICH LLC ” Practice Location

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