Organization
EUGENE GILES SR MD PSC
Active
Organization
EUGENE GILES SR MD PSC
Active
Other names
OMNI MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENE GILES SR. MD (SOLO MEMBER OWNER)
(502) 776-1177
Entity
Organization
Contact information
Practice address
2746 VIRGINIA AVE, LOUISVILLE, KY 40211-3417
(502) 776-1177
(502) 772-1761
Mailing address
2746 VIRGINIA AVE, LOUISVILLE, KY 40211-3417
(502) 776-1177
(502) 772-1761
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
22657
KY
207R00000X
Internal Medicine Physician
Primary
22657
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000062872
ANTHEM
KY
01
—
0400136
UNITED HEALTHCARE
—
01
—
1049423
PASSPORT
KY
05
—
64226574
—
KY
Enumeration date
10/26/2006
Last updated
02/24/2009
Update your record
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