Active NPI
Antonio L Gibson Sr.
- Vehicle Modifications Contractor
- Greenfield, IN
National Provider Identifier
1508624016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vehicle Modifications Contractor
- License
- 202303151673406
- Practice address
- 594 Geronimo Dr
Greenfield, IN 46140-9375 - Phone
- (317) 413-8137
- NPI assigned
- Mar 8, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vehicle Modifications Contractor | 171WV0202X | 202303151673406 | IN | Primary |
| Driver | 172A00000X | 202303151673406 | IN |
Addresses
Primary practice location
594 Geronimo Dr
Greenfield, IN 46140-9375
Mailing address
594 Geronimo Dr
Greenfield, IN 46140-9375
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 202303151673406 | IN | MD | Vehicle Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1710374400000",
"number": "1508624016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "594 GERONIMO DR",
"city": "GREENFIELD",
"state": "IN",
"postal_code": "461409375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "594 GERONIMO DR",
"city": "GREENFIELD",
"state": "IN",
"postal_code": "461409375",
"telephone_number": "317-413-8137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "ANTONIO",
"middle_name": "L",
"name_suffix": "Sr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-03-08",
"last_updated": "2024-03-14",
"certification_date": "2024-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "171WV0202X",
"taxonomy_group": "",
"desc": "Contractor, Vehicle Modifications",
"state": "IN",
"license": "202303151673406",
"primary": true
},
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "IN",
"license": "202303151673406",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenfield, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.