Healthcare Provider Details

I. General information

NPI: 1487612909
Provider Name (Legal Business Name): GILBERT MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 80 MAIN ST
GILBERT WV
25621-0925
US

IV. Provider business mailing address

RT 80 MAIN ST PO BOX 925
GILBERT WV
25621-0925
US

V. Phone/Fax

Practice location:
  • Phone: 304-664-3223
  • Fax: 304-664-3284
Mailing address:
  • Phone: 304-664-3223
  • Fax: 304-664-3284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateWV

VIII. Authorized Official

Name: MR. ROBERT ROSCOE MAYS III
Title or Position: CEO
Credential:
Phone: 304-583-6541