MEDICARE: GILG PROSTHETICS, INC.

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	335E00000X	Prosthetic/Orthotic Supplier	PRO26	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	A712	OTHER	FL	WELLCARE - MEDICARE HMO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	015967	OTHER	FL	VISTA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	M2475	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1831157684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILG PROSTHETICS, INC.

Provider Business Mailing Address
First Line	:	87 W HOOD DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-3019
Country	:	US
Telephone Number	:	850-474-0414
Fax Number	:	850-474-0409

Provider Business Practice Location Address
First Line	:	87 W HOOD DR
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32534-3019
Country	:	US
Telephone Number	:	850-474-0414
Fax Number	:	850-474-0409

Authorized Official
Title or Position	:	PRESIDENT/CERTIFIED PROSTHETIST
Name	:	MR. KEVIN JOHN GILG
Credential	:	C.P.
Telephone Number	:	850-474-0414

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	08/17/2018

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Directions to “GILG PROSTHETICS, INC. ” Practice Location

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