Provider Demographics
NPI:1861704587
Name:GAINESBORO ULTIMATE MED SERVICE CORPORATION
Entity type:Organization
Organization Name:GAINESBORO ULTIMATE MED SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YENNIER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-303-0012
Mailing Address - Street 1:179 BUCK BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38562
Mailing Address - Country:US
Mailing Address - Phone:931-303-0012
Mailing Address - Fax:931-241-5444
Practice Address - Street 1:179 BUCK BRANCH LN
Practice Address - Street 2:
Practice Address - City:GAINESBORO
Practice Address - State:TN
Practice Address - Zip Code:38562
Practice Address - Country:US
Practice Address - Phone:931-303-0012
Practice Address - Fax:931-241-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care