Provider Demographics
NPI:1093961351
Name:MIDWEST GASTROENTEROLOGY CONSULTANTS. P.C.
Entity Type:Organization
Organization Name:MIDWEST GASTROENTEROLOGY CONSULTANTS. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:A
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-822-9733
Mailing Address - Street 1:13276 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1706
Mailing Address - Country:US
Mailing Address - Phone:314-822-9733
Mailing Address - Fax:314-822-9838
Practice Address - Street 1:13276 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1706
Practice Address - Country:US
Practice Address - Phone:314-822-9733
Practice Address - Fax:314-822-9838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103770207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000095194Medicare PIN
MOF83209Medicare UPIN