Provider Demographics
NPI:1073619920
Name:GASTROENTEROLOGY ASSOCIATES OF NORTH MS
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF NORTH MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:FRANCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-234-9888
Mailing Address - Street 1:1208 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3597
Mailing Address - Country:US
Mailing Address - Phone:662-234-9888
Mailing Address - Fax:662-281-8927
Practice Address - Street 1:1208 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-3597
Practice Address - Country:US
Practice Address - Phone:662-234-9888
Practice Address - Fax:662-281-8927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05981073Medicaid
MSC01061Medicare ID - Type Unspecified