NPIMap

Organization Active NPI

Three Gables Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Proctorville, OH
National Provider Identifier
1124083878
Registry record updated Jan 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
THREE GABLES SURGERY CENTER LLC
Practice address
5897 State Route 7
Proctorville, OH 45669-8852
Phone
(740) 886-9911
Fax
(740) 886-9922
NPI assigned
Apr 18, 2006
Last updated
Jan 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2021

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

Authorized official

Name
Virginia Ann Cox
Title
Office Manager
Phone
(740) 886-9911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

5897 State Route 7
Proctorville, OH 45669-8852

Mailing address

PO Box 490
Proctorville, OH 45669-0490
Phone (740) 886-9911

Other identifiers 3

IdentifierTypeStateIssuer
2338447MedicaidOH
6905009000MedicaidWV
01500388MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200212000803 OH Part B Supplier - Ambulatory Surgical Center 3072528033 Practice locations: Proctorville, OH

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Three Gables Surgery CenterCCN 36C0001327
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1124083878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 490",
            "city": "PROCTORVILLE",
            "state": "OH",
            "postal_code": "456690490",
            "telephone_number": "740-886-9911",
            "fax_number": "740-886-9922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5897 STATE ROUTE 7",
            "city": "PROCTORVILLE",
            "state": "OH",
            "postal_code": "456698852",
            "telephone_number": "740-886-9911",
            "fax_number": "740-886-9922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE GABLES SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-19",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "740-886-9911"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2338447",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6905009000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01500388",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Proctorville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.