MEDICARE: GLI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	101016018	VA
2	261Q00000X	Clinic/Center	101239530	VA

General Provider Information

NPI Number	:	1306147798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLI LLC

Provider Business Mailing Address
First Line	:	1021 EDEN WAY N
Second Line	:	124
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-2776
Country	:	US
Telephone Number	:	757-842-6757
Fax Number	:	757-842-6786

Provider Business Practice Location Address
First Line	:	1021 EDEN WAY N
Second Line	:	124
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-2776
Country	:	US
Telephone Number	:	757-842-6757
Fax Number	:	757-842-6786

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. GARY LEE INSLEY
Credential	:	N.D.
Telephone Number	:	757-842-6757

Provider Enumeration Date	:	11/16/2010
Last Update Date	:	07/16/2013

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