Provider Demographics
NPI:1073551172
Name:GASTROENTEROLOGY ASSOCSO
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LANIER
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-933-0960
Mailing Address - Street 1:2700 10TH AVE S
Mailing Address - Street 2:STE 406
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1250
Mailing Address - Country:US
Mailing Address - Phone:205-933-0960
Mailing Address - Fax:205-933-0962
Practice Address - Street 1:2700 10TH AVE S
Practice Address - Street 2:STE 406
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1250
Practice Address - Country:US
Practice Address - Phone:205-933-0960
Practice Address - Fax:205-933-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCM0081Medicare PIN