Provider Demographics
NPI:1144499567
Name:GINGER-K CENTER
Entity type:Organization
Organization Name:GINGER-K CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TUBBS-GINGERICH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, LE, CLT
Authorized Official - Phone:408-782-1028
Mailing Address - Street 1:16360 MONTEREY ROAD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-5406
Mailing Address - Country:US
Mailing Address - Phone:408-782-1028
Mailing Address - Fax:408-782-1061
Practice Address - Street 1:16360 MONTEREY ROAD
Practice Address - Street 2:SUITE 270
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5406
Practice Address - Country:US
Practice Address - Phone:408-782-1028
Practice Address - Fax:408-782-1061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GINGER-K CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-29
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WA2000X, 163WX0200X, 163W00000X
CA44990332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No163WX0200XNursing Service ProvidersRegistered NurseOncologyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1144499567Medicare NSC