GSG PRIDE HEALTHCARE LLC NPI 1437622701

NPI Information

NPI: 1437622701
Provider Name: GSG PRIDE HEALTHCARE LLC

Doing Business As: MEDICAL PRACTICE

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
8391 S SHADY TRAIL DR
PENDLETON, IN
ZIP 46064
Phone: (317) 507-2395
Get Directions

GSG PRIDE HEALTHCARE LLC is a primary care clinic center in Pendleton, IN. GSG PRIDE HEALTHCARE LLC NPI is 1437622701. The provider is registered as an organization entity type.
The provider Is Doing Business As Medical Practice.

The provider's business location address is:

8391 S SHADY TRAIL DR
PENDLETON, IN
ZIP 46064-652
Phone: (317) 507-2395

The provider's authorized official is Taris D Gonzalez .
The authorized official title is Nurse Practitioner/owner and has the following contact phone number (317) 743-0009.

The enumeration date for this NPI number is 1/9/2019 and was last updated on 1/30/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes
2	261QR1300X	Clinic/Center	Rural Health			No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1821290743	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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