Organization
GSG PRIDE HEALTHCARE LLC
Active
Other names
Medical Practice, Taris Gonzalez
Organization subpart
No
Provider details
NPI number
Authorized official
TARIS D GONZALEZ NP (NURSE PRACTITIONER/OWNER)
(317) 743-0009
Entity
Organization
Contact information
Practice address
426 N CRYSTAL DR, FORTVILLE, IN 46040-1688
(317) 743-0009
Mailing address
426 N CRYSTAL DR, FORTVILLE, IN 46040-1688
(317) 743-0009
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821290743
—
IN
Enumeration date
01/09/2019
Last updated
07/28/2026
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