Provider Demographics
NPI:1538156229
Name:GIBSON & HARSHAW, LLC
Entity type:Organization
Organization Name:GIBSON & HARSHAW, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-657-4413
Mailing Address - Street 1:100 ZEID BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-6069
Mailing Address - Country:US
Mailing Address - Phone:903-657-4413
Mailing Address - Fax:903-655-0225
Practice Address - Street 1:100 ZEID BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-6069
Practice Address - Country:US
Practice Address - Phone:903-657-4413
Practice Address - Fax:903-655-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006761251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH9277OtherBCBS PROVIDER NUMBER
TX006761OtherSTATE LICENSE NUMBER
TX024320601Medicaid
TX459266Medicare Oscar/Certification