=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699852681
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GILBERT MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | RT 80 MAIN STREET
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25621-0925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-664-3223
-----------------------------------------------------
Fax | 304-664-3284
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 925 RT 80 MAIN STREET
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25621-0925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-664-3223
-----------------------------------------------------
Fax | 304-664-3284
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. ROBERT ROSCOE MAYS
-----------------------------------------------------
Credential | III
-----------------------------------------------------
Telephone | 304-583-6541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0050X
-----------------------------------------------------
Taxonomy Name | Non-Surgical Family Planning Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------