National Provider Identifier Database

GSG PRIDE HEALTHCARE LLC
Primary Care


Contact Information

GSG PRIDE HEALTHCARE LLC
8391 S SHADY TRAIL DR
PENDLETON, IN46064-8652
Phone: 317-507-2395
Fax:
Website:
Specialty Taxonomy Code
* Primary Care 261QP2300X
Rural Health 261QR1300X

* Indicates primary specialty

NPI Profile & details for GSG PRIDE HEALTHCARE LLC

NPI Number 1437622701
Legal business name
LBN
GSG PRIDE HEALTHCARE LLC
Authorized official TARIS GONZALEZ - (NURSE PRACTITIONER/OWNER)
Entity Organization
Organization subpart No
Enumeration date 01/09/2019
Last updated 01/30/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • IN Medicaid: 1821290743

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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