Provider Demographics
NPI:1760501225
Name:BELL, GINA S (MD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:S
Last Name:BELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5009
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-5009
Mailing Address - Country:US
Mailing Address - Phone:615-221-3642
Mailing Address - Fax:615-371-4600
Practice Address - Street 1:1698 OLD LEBANON RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9662
Practice Address - Country:US
Practice Address - Phone:270-465-3561
Practice Address - Fax:270-789-6119
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116166207V00000X
KY42013207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116166Medicaid
OH2766289Medicaid
KY7100040530Medicaid
KY7100040530Medicaid
OH2766289Medicaid
OHBE4216851Medicare PIN
IL256510125Medicare PIN
OH4216855Medicare PIN