Provider Demographics
NPI:1154442630
Name:GASTROENTEROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES PA
Other - Org Name:GASTROENTEROLOGY ASSOCIATES ENDOSCOPY UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-328-3300
Mailing Address - Street 1:415 N CENTER ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5036
Mailing Address - Country:US
Mailing Address - Phone:828-328-3300
Mailing Address - Fax:828-328-9101
Practice Address - Street 1:415 N CENTER ST STE 300
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5036
Practice Address - Country:US
Practice Address - Phone:828-328-3300
Practice Address - Fax:828-328-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34C0001119261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34C0001119OtherNC STATE LICENSE NUMBER
NC34C0001119OtherNC STATE LICENSE NUMBER