Basic Information
| Provider Information | |||||||||
| NPI: | 1427415058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILLS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | WINSTON | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2331 FRANKLIN RD SW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240141111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407251226 | ||||||||
| FaxNumber: | 5408575306 | ||||||||
| Practice Location | |||||||||
| Address1: | 2331 FRANKLIN RD SW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240141111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407251226 | ||||||||
| FaxNumber: | 5408575306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2016 | ||||||||
| LastUpdateDate: | 08/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 0110005190 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | 0110005190 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1427415058 | 01 | VA | TRICARE | OTHER | 1427415058 | 01 | VA | ANTHEM MEDIGAP | OTHER | 1427415058 | 01 | VA | MEDICAID QMB | OTHER | 1427415058 | 01 | VA | CCC VIRGINIA PREMIER | OTHER | 1427415058 | 01 | VA | UMWA | OTHER | 1427415058 | 01 | VA | HUMANA MEDICARE | OTHER | 1427415058 | 01 | VA | INTOTAL | OTHER | 1427415058 | 01 | VA | AETNA | OTHER | 14274150585 | 01 | VA | OPTIMA HEALTH PLAN | OTHER |