MARCENE R. MCVAY GILLAM MD
NPI 1962627984
Surgery - Pediatric Surgery in San Antonio, TX

Q: What is Marcene Mcvay Gillam's NPI number?

The NPI number for Marcene Mcvay Gillam is 1962627984. It was assigned to this individual provider in the NPPES registry on April 16, 2007. The provider is also known as Marcene Renee Mcvay MD.

Q: What is Marcene Mcvay Gillam's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Pediatric Surgery, with taxonomy code 2086S0120X.

Active since April 16, 2007PECOS Enrolled

4502 MEDICAL DR, SAN ANTONIO, TX 78229(210) 358-4000(210) 358-4775 Get Directions Write a Review

NPPES record last updated: October 18, 2024. Verified against the NPPES registry weekly; last sync: August 30, 2026.

Record update history: Sep 3, 2024, Jul 29, 2024, Dec 7, 2023 and 1 more (4 updates tracked since 2017).

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About Marcene R. Mcvay Gillam Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARCENE R. MCVAY GILLAM MD (NPI 1962627984) is an individual pediatric surgery provider in San Antonio, Texas, licensed in Texas (P3650) and active in the NPI registry since April 2007. She is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1962627984

Entity TypeIndividualFemale

Primary Taxonomy2086S0120X

Provider Legal NameMARCENE R. MCVAY GILLAMCredential: MD

Location Address4502 MEDICAL DRSan Antonio, TX 78229-4402

Mailing AddressPo Box 6908Springdale, AR 72766-6908 · (501) 349-3182

Phone(210) 358-4000

Fax(210) 358-4775

Sole ProprietorNo

Enumeration DateApril 16, 2007

Last NPPES UpdateOctober 18, 20244 updates tracked since enumeration

NPPES CertifiedOctober 18, 2024

✔ NPI 1962627984 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgery · Pediatric SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code2086S0120X

Licenses✔ Licensed in TX · P3650✔ Licensed in OK · 42264✔ Licensed in AR · E-4933

Definition

A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.

Also ListedSurgeryTaxonomy 208600000X · License P3650 (TX), E-4933 (AR)

4502 MEDICAL DR, San Antonio, TX 78229

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Other Names 1

Former Name (1)Marcene Renee Mcvay Md

Secondary Practice Locations 2

Location 16151 S Yale Ave Ste 1305Tulsa, OK 74136-1907 · Phone (918) 494-9450 · Fax (918) 494-9437

Location 23623 Johnson Mill Blvd Ste 101Springdale, AR 72762-6412 · Phone (479) 222-0190 · Fax (800) 730-1097

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Arkansas Blue Cross and Blue Shield, Baylor Scott and White Health Plan, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Marcene R. Mcvay Gillam Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EDUARDO N. POLLONO MD

Internal Medicine (Cardiovascular Disease)