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General NPI Number Information
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NPI Number | 1063864056
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Entity Type | Organization
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Legal Business Name | GRAVES GILBERT CLINIC PLLC
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Dates
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Enumeration Date | 07/01/2016
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 165 NATCHEZ TRACE AVE STE 100
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7947
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Country | US
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Telephone | 270-782-7800
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Fax | 270-843-0779
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Provider Business Mailing Address
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Address Line | 201 PARK ST
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City | BOWLING GREEN
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State | KY
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Zip | 42101-1708
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Country | US
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Telephone | 270-781-5111
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Fax | 270-783-0454
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL E DERAMO
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Credential | DHA
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Telephone | 270-780-0549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | HME01042
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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