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
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