Intercare Medical, Corp

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

Legal business name

INTERCARE MEDICAL, CORP

Practice address

3540 Wheeler Rd Ste 307
Augusta, GA 30909-1887

Phone

(706) 432-1111

Fax

(706) 945-0638

NPI assigned

Jan 6, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jon C Gibbs, M.D.

Title

Physician

Phone

(706) 432-1111

Specialties & licenses 1

Addresses

Other names 1

• Intercare Medical Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578268800000",
    "number": "1083253140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 CONIFER CIR",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309094506",
            "telephone_number": "706-465-6260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 WHEELER RD STE 307",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309091887",
            "telephone_number": "706-432-1111",
            "fax_number": "706-945-0638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCARE MEDICAL, CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-06",
        "last_updated": "2020-01-06",
        "certification_date": "2020-01-06",
        "status": "A",
        "authorized_official_last_name": "GIBBS",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "706-432-1111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Intercare Medical",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Pain Clinic/Center in Augusta, GA
• Providers in Augusta, GA by specialty
• Pain Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.