Provider Demographics
NPI:1124083878
Name:THREE GABLES SURGERY CENTER LLC
Entity type:Organization
Organization Name:THREE GABLES SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-886-9911
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-0490
Mailing Address - Country:US
Mailing Address - Phone:740-886-9911
Mailing Address - Fax:740-886-9922
Practice Address - Street 1:5897 STATE ROUTE 7
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-8852
Practice Address - Country:US
Practice Address - Phone:740-886-9911
Practice Address - Fax:740-886-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6905009000Medicaid
OH2338447Medicaid
KY01500388Medicaid
KY01500388Medicaid