Provider Demographics
NPI:1013001858
Name:WOMENS GASTROENTEROLOGY CONSULTANTS, PSC
Entity Type:Organization
Organization Name:WOMENS GASTROENTEROLOGY CONSULTANTS, PSC
Other - Org Name:GASTROENTEROLOGY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-263-0022
Mailing Address - Street 1:160 N EAGLE CREEK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2121
Mailing Address - Country:US
Mailing Address - Phone:859-263-0022
Mailing Address - Fax:859-263-4666
Practice Address - Street 1:160 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2121
Practice Address - Country:US
Practice Address - Phone:859-263-0022
Practice Address - Fax:859-263-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65935272Medicaid
KY9590117900Medicaid
KY9590117900Medicaid