Provider Demographics
NPI:1083764526
Name:ANNISTON GASTROENTEROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:ANNISTON GASTROENTEROLOGY ASSOCIATES
Other - Org Name:PANKAJ K. KASHYAP, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-237-3284
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-0126
Mailing Address - Country:US
Mailing Address - Phone:256-237-3284
Mailing Address - Fax:256-237-4104
Practice Address - Street 1:1720 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-3811
Practice Address - Country:US
Practice Address - Phone:256-237-3284
Practice Address - Fax:256-237-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19468174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529909260Medicaid
AL529909260Medicaid