Provider Demographics
NPI:1003147364
Name:GASTROENTEROLOGY INSTITUTE, INC.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY INSTITUTE, INC.
Other - Org Name:GII
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOUSSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-868-7773
Mailing Address - Street 1:PO BOX 4041
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4041
Mailing Address - Country:US
Mailing Address - Phone:985-868-7773
Mailing Address - Fax:985-868-4242
Practice Address - Street 1:855 BELANGER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4463
Practice Address - Country:US
Practice Address - Phone:985-868-7773
Practice Address - Fax:985-868-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201030207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1099058Medicaid
1922116631OtherNPI
LAH14198Medicare UPIN
LAA30853Medicare PIN