Provider Demographics
NPI:1154406619
Name:GAMMA HEALTHCARE INC
Entity type:Organization
Organization Name:GAMMA HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-727-5600
Mailing Address - Street 1:1717 W MAUD ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-4003
Mailing Address - Country:US
Mailing Address - Phone:573-727-5600
Mailing Address - Fax:573-785-0753
Practice Address - Street 1:1717 W MAUD ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-4003
Practice Address - Country:US
Practice Address - Phone:573-727-5600
Practice Address - Fax:573-785-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL9259424335V00000X
MO9822335V00000X, 335V00000X
MS99-9-103335V00000X
TN223-0076335V00000X
AROT00222335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO470766OtherHEALTHLINK
MS7708309Medicaid
MO2458112OtherUHC MEDICARE COMPLETE
AR135925709Medicaid
MO711734103Medicaid
MO162202OtherBLUE CROSS BLUE SHIELD
MO630001686OtherMEDICARE RAILROAD
MO2458112OtherUNITED HEALTHCARE
AR135925709Medicaid
MO000013553Medicare PIN
MO470766OtherHEALTHLINK
AR135925709Medicaid
AL102G638325Medicare PIN
MO2458112OtherUHC MEDICARE COMPLETE