Healthcare Provider Details

I. General information

NPI: 1174829519
Provider Name (Legal Business Name): GIBSON HEALTHCARE ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W SAMPLE RD SUITE 4
POMPANO BEACH FL
33073-3062
US

IV. Provider business mailing address

2400 W SAMPLE RD SUITE 4
POMPANO BEACH FL
33073-3062
US

V. Phone/Fax

Practice location:
  • Phone: 954-580-1036
  • Fax: 954-580-1099
Mailing address:
  • Phone: 954-580-1036
  • Fax: 954-580-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: XUNDA A GIBSON
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 954-580-1036