Healthcare Provider Details

I. General information

NPI: 1902810658
Provider Name (Legal Business Name): MARVIN GILL & ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S. KEARNEY
CLARENDON TX
79226-0276
US

IV. Provider business mailing address

PO BOX 276
CLARENDON TX
79226-0276
US

V. Phone/Fax

Practice location:
  • Phone: 806-874-0248
  • Fax: 806-874-2050
Mailing address:
  • Phone: 806-874-0248
  • Fax: 806-874-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number7352
License Number StateTX

VIII. Authorized Official

Name: MRS. CAROLYN S. GILL
Title or Position: OWNER
Credential:
Phone: 806-874-2048