Provider Demographics
NPI:1013202704
Name:ADVANCED GASTROENTEROLOGY CENTER PA
Entity Type:Organization
Organization Name:ADVANCED GASTROENTEROLOGY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ATIF
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHZAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-893-4488
Mailing Address - Street 1:PO BOX 131869
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77393-1869
Mailing Address - Country:US
Mailing Address - Phone:281-943-2800
Mailing Address - Fax:877-667-5192
Practice Address - Street 1:26103 I-45 N
Practice Address - Street 2:SUITE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-943-2800
Practice Address - Fax:877-667-5192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7618207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty