Provider Demographics
NPI:1487612909
Name:GILBERT MEDICAL CENTER
Entity type:Organization
Organization Name:GILBERT MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ROSCOE
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:304-583-6541
Mailing Address - Street 1:RT 80 MAIN ST
Mailing Address - Street 2:PO BOX 925
Mailing Address - City:GILBERT
Mailing Address - State:WV
Mailing Address - Zip Code:25621-0925
Mailing Address - Country:US
Mailing Address - Phone:304-664-3223
Mailing Address - Fax:304-664-3284
Practice Address - Street 1:RT 80 MAIN ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:WV
Practice Address - Zip Code:25621-0925
Practice Address - Country:US
Practice Address - Phone:304-664-3223
Practice Address - Fax:304-664-3284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0040381000Medicaid
WV511848Medicare ID - Type Unspecified