=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538837760
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEC MEDICAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2021
-----------------------------------------------------
Last Update Date | 09/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16325 TAYLOR PL STE 300
-----------------------------------------------------
City | ABINGDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24211-7643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-619-1140
-----------------------------------------------------
Fax | 276-883-6713
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 549
-----------------------------------------------------
City | ABINGDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24212-0549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-619-1140
-----------------------------------------------------
Fax | 276-884-6713
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONSULTANT DIRECTOR
-----------------------------------------------------
Name | SUSAN JANET MOLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 276-619-1140
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------