Healthcare Provider Details

I. General information

NPI: 1811585144
Provider Name (Legal Business Name): GINGERICH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2021
Last Update Date: 12/19/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 HAMPTON AVE STE 11B
GREENVILLE SC
29601-1044
US

IV. Provider business mailing address

210 EDGEWOOD DR
GREENVILLE SC
29605-4240
US

V. Phone/Fax

Practice location:
  • Phone: 937-623-1975
  • Fax:
Mailing address:
  • Phone: 937-623-1975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: CODY GINGERICH
Title or Position: OWNER
Credential:
Phone: 937-623-1975