Provider Demographics
NPI:1083747380
Name:GASTROENTEROLOGY SPECIALTIES, P.C.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY SPECIALTIES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-465-4545
Mailing Address - Street 1:4545 R ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3799
Mailing Address - Country:US
Mailing Address - Phone:402-465-4545
Mailing Address - Fax:402-465-3621
Practice Address - Street 1:4545 R ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3799
Practice Address - Country:US
Practice Address - Phone:402-465-4545
Practice Address - Fax:402-465-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE001-005685907174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-13Medicaid