Provider Demographics
NPI:1073607974
Name:WESTGLEN GASTROINTESTINAL CONSULTANTS PA
Entity Type:Organization
Organization Name:WESTGLEN GASTROINTESTINAL CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-962-2122
Mailing Address - Street 1:7230 RENNER RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9901
Mailing Address - Country:US
Mailing Address - Phone:913-962-2122
Mailing Address - Fax:913-962-2422
Practice Address - Street 1:7230 RENNER RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9901
Practice Address - Country:US
Practice Address - Phone:913-962-2122
Practice Address - Fax:913-969-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSK330000Medicare PIN
KS110605Medicare PIN
MOK330000AMedicare PIN