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General NPI Number Information
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NPI Number | 1417103276
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Entity Type | Organization
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Legal Business Name | GWIM ENTERPRISES, LLC
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 200 N CRAWFORD ST
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City | TOMPKINSVILLE
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State | KY
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Zip | 42167-1617
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Country | US
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Telephone | 270-634-2089
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 952
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City | TOMPKINSVILLE
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State | KY
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Zip | 42167-0952
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROCKIE MCDANIEL
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Credential |
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Telephone | 270-403-5211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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