Provider Demographics
NPI:1033217534
Name:COMMUNITY GASTROENTEROLOGY PC
Entity Type:Organization
Organization Name:COMMUNITY GASTROENTEROLOGY PC
Other - Org Name:DR JOSEPH KATZ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:I
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-355-4191
Mailing Address - Street 1:1400 N RITTER AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:INDPLS
Mailing Address - State:IN
Mailing Address - Zip Code:46219
Mailing Address - Country:US
Mailing Address - Phone:317-355-4191
Mailing Address - Fax:317-355-1131
Practice Address - Street 1:1400 N RITTER AVE
Practice Address - Street 2:STE 210
Practice Address - City:INDPLS
Practice Address - State:IN
Practice Address - Zip Code:46219
Practice Address - Country:US
Practice Address - Phone:317-355-4191
Practice Address - Fax:317-355-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034292207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000087872OtherANTHEM
IN522280Medicare PIN