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Contact Information

GSG PRIDE HEALTHCARE LLC
8391 S SHADY TRAIL DR
PENDLETON, IN46064-8652
 Phone: 317-507-2395
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Primary Care

261QP2300X
 

Rural Health

261QR1300X B4[14] Rural Health Clinic
Indicates primary specialty

NPI Profile & details for GSG PRIDE HEALTHCARE LLC

NPI Number 1437622701
LBN Legal business name GSG PRIDE HEALTHCARE LLC
Authorized official TARIS GONZALEZ - (NURSE PRACTITIONER/OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/09/2019
Last updated 01/30/2020 - About 6 years ago
Identifiers
IN Medicaid 1821290743
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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