Provider Demographics
NPI:1003926056
Name:GASTROINTESTINAL SPECIALISTS, PC
Entity Type:Organization
Organization Name:GASTROINTESTINAL SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANGESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUKLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-314-1010
Mailing Address - Street 1:104 PHYSICIANS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2100
Mailing Address - Country:US
Mailing Address - Phone:256-314-1010
Mailing Address - Fax:256-314-0005
Practice Address - Street 1:104 PHYSICIANS DR
Practice Address - Street 2:SUITE A
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2100
Practice Address - Country:US
Practice Address - Phone:256-314-1010
Practice Address - Fax:256-314-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18418174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529919500Medicaid
AL529919500Medicaid