Provider Demographics
NPI:1356997662
Name:TRIPLE GEM HEALTHCARE, INC.
Entity type:Organization
Organization Name:TRIPLE GEM HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:833-724-6688
Mailing Address - Street 1:4222 22ND AVE S # 531631
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-9998
Mailing Address - Country:US
Mailing Address - Phone:833-724-6688
Mailing Address - Fax:833-724-6688
Practice Address - Street 1:2650 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-1108
Practice Address - Country:US
Practice Address - Phone:833-724-6688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty