Provider Demographics
NPI:1104803428
Name:MARVIN GILL & ASSOC
Entity type:Organization
Organization Name:MARVIN GILL & ASSOC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-874-0248
Mailing Address - Street 1:304 S KEARNEY ST
Mailing Address - Street 2:PO BOX 276
Mailing Address - City:CLARENDON
Mailing Address - State:TX
Mailing Address - Zip Code:79226-0276
Mailing Address - Country:US
Mailing Address - Phone:806-874-0248
Mailing Address - Fax:806-874-0250
Practice Address - Street 1:304 S KEARNEY ST
Practice Address - Street 2:
Practice Address - City:CLARENDON
Practice Address - State:TX
Practice Address - Zip Code:79226-0276
Practice Address - Country:US
Practice Address - Phone:806-874-0248
Practice Address - Fax:806-874-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0044614332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies