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1710133905 deactivated on May 17, 2018

NPI 1710133905 deactivated on May 17, 2018.

profile-icon Basic Information

Practice Location , ,
Practice Location Phone
Practice Location Fax
Specialty InNot specified
Medical SchoolOther
Graduation Year2008
NPI ?1710133905
PECOS ID5799701256
Enrollment IDI20081203000754
Entity Type
Enumeration Date ?
Last Update Date ?
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).
PECOS: Provider Enrollment, Chain, and Ownership System.

Medicare-icon Medicare Participation of 1710133905

Accepts Medicare AssignmentYes
Report Quality MeasuresYes
Use Electronic Health Records
Committed to Teart Health Through the Million HeartsĀ® initiative

affiliation-icon Hospital & Group Practice Affiliations of 1710133905

Medical Group PracticeGilbert Barbee Moore And Mcilvoy Psc