Basic Information
| Provider Information | |||||||||
| NPI: | 1427655240 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GAPS HEALTH IL, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95590 | ||||||||
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| City: | SOUTH JORDAN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840950590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013529500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1599 KEOKUK ST | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 623411137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178473931 | ||||||||
| FaxNumber: | 2178472067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2020 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | HUNTER | ||||||||
| AuthorizedOfficialFirstName: | JODY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7348120996 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.