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General NPI Number Information
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NPI Number | 1821392333
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Entity Type | Individual
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Provider Name | MR. JIM GILBERT
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Gender | Male
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 5760 S ELAND DR
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City | FORT MOHAVE
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State | AZ
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Zip | 86426-9293
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Country | US
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Telephone | 928-533-7221
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Fax | 888-503-3633
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Provider Business Mailing Address
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Address Line | 14615 N 31ST LN
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City | PHOENIX
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State | AZ
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Zip | 85053-4809
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Country | US
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Telephone | 928-533-7221
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Fax | 888-503-3633
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 20634211
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 20634211
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License Number State | AZ
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