Provider Demographics
NPI:1164645271
Name:TEXOMA GASTROENTEROLOGY CONSULTANTS, PA
Entity Type:Organization
Organization Name:TEXOMA GASTROENTEROLOGY CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-892-9179
Mailing Address - Street 1:425 N HIGHLAND
Mailing Address - Street 2:# 130
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7383
Mailing Address - Country:US
Mailing Address - Phone:903-892-9179
Mailing Address - Fax:903-868-2317
Practice Address - Street 1:425 N HIGHLAND AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7377
Practice Address - Country:US
Practice Address - Phone:903-892-9179
Practice Address - Fax:903-868-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093982901Medicaid
TXJH46Medicare ID - Type Unspecified