| Gill Medical Group, Inc. | |
|
999 S Fairmont Ave Ste 235 Lodi CA 95240-5100 | |
| (209) 334-0799 | |
| Not Available |
| Full Name | Gill Medical Group, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 999 S Fairmont Ave Ste 235, Lodi, California |
| Authorized Official Name and Position | Ruby Kaur Srao (PRESIDENT) |
| Authorized Official Contact | 2093340799 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gill Medical Group, Inc. Po Box 2597 Lodi CA 95241-2597 Ph: (209) 334-6583 | Gill Medical Group, Inc. 999 S Fairmont Ave Ste 235 Lodi CA 95240-5100 Ph: (209) 334-0799 |
| NPI Number | 1235642588 |
|---|---|
| Provider Enumeration Date | 11/08/2017 |
| Last Update Date | 12/11/2017 |
| Medicare PECOS PAC ID | 5799045621 |
|---|---|
| Medicare Enrollment ID | O20180214000241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235642588 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A131215 (California) | Primary |
| Provider Name | Ruby K Gill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609147354 PECOS PAC ID: 6507184488 Enrollment ID: I20151222000793 |
| Provider Name | Virginia Vicky Inthavong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932741139 PECOS PAC ID: 8820320872 Enrollment ID: I20210309002875 |
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