Provider Demographics
NPI:1194270926
Name:GYPSUM MEDICAL ASSOCIATES OF CALIFORNIA PC
Entity type:Organization
Organization Name:GYPSUM MEDICAL ASSOCIATES OF CALIFORNIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GLIMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-363-9500
Mailing Address - Street 1:4805 PRIME PKWY
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7002
Mailing Address - Country:US
Mailing Address - Phone:815-363-9500
Mailing Address - Fax:
Practice Address - Street 1:4805 PRIME PKWY
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7002
Practice Address - Country:US
Practice Address - Phone:815-363-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty