Provider Demographics
NPI:1194263160
Name:PAMELA GILL
Entity type:Organization
Organization Name:PAMELA GILL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:STNA
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:STNA
Authorized Official - Phone:513-255-7444
Mailing Address - Street 1:1705 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044
Mailing Address - Country:US
Mailing Address - Phone:513-255-7444
Mailing Address - Fax:
Practice Address - Street 1:1705 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044
Practice Address - Country:US
Practice Address - Phone:513-255-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1974
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401669890714251E00000X
OHFWS4561347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No347C00000XTransportation ServicesPrivate Vehicle