Provider Demographics
NPI:1174670723
Name:GASTROINTESTINAL INSTITUTE, LLC.
Entity Type:Organization
Organization Name:GASTROINTESTINAL INSTITUTE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-451-1123
Mailing Address - Street 1:2200 JACOBSSEN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-5516
Mailing Address - Country:US
Mailing Address - Phone:309-451-1121
Mailing Address - Fax:309-451-1212
Practice Address - Street 1:2200 JACOBSSEN DR STE A
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-5516
Practice Address - Country:US
Practice Address - Phone:309-451-1121
Practice Address - Fax:309-451-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7003056261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50492OtherBLUECROSSBLUESHIELD OF ILLINOIS
IL50492OtherBLUECROSSBLUESHIELD OF ILLINOIS
IL213500Medicare PIN
ILP00000460Medicare PIN
IL=========001Medicaid