Provider Demographics
NPI:1003505157
Name:MODERN GASTROENTEROLOGY
Entity Type:Organization
Organization Name:MODERN GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:THUSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-335-5511
Mailing Address - Street 1:4501 N HIGHWAY 7 STE 8
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-8201
Mailing Address - Country:US
Mailing Address - Phone:806-928-7147
Mailing Address - Fax:
Practice Address - Street 1:102 E CENTRAL ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-3100
Practice Address - Country:US
Practice Address - Phone:479-335-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty