Most Relevant Information
Provider Data
| NPI Number: | 1003588427 |
| Provider Name: | MIKE W GIBSON |
| Entity Type: | Individual |
| Taxonomy Code: | 343900000X |
| Specialty: | Non-emergency Medical Transport (VAN) |
| License Number: | 804211277 |
Most Important Dates
| Enumeration Date: | 10/04/2021 |
| Last Updated: | 10/04/2021 |
Provider Practice Location
617 N EBRITE ST
MESQUITE
TX
751493453
Practice Location Phone/Fax
| Phone: | 9728509945 |
| Fax: | 8664965016 |
Provider Mailing Location
3330 N GALLOWAY AVE STE 304-119
MESQUITE
TX
751504728
Provider Mailing Phone/Fax
| Phone: | 9725719273 |
| Fax: | 8664965016 |