Provider Demographics
NPI:1275518078
Name:G I MEDICAL GROUP OF FRESNO INC
Entity Type:Organization
Organization Name:G I MEDICAL GROUP OF FRESNO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-449-1703
Mailing Address - Street 1:6169 N THESTA ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5266
Mailing Address - Country:US
Mailing Address - Phone:559-449-1703
Mailing Address - Fax:559-449-1140
Practice Address - Street 1:6169 N THESTA ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5266
Practice Address - Country:US
Practice Address - Phone:559-449-1703
Practice Address - Fax:559-449-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30605207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ88709ZMedicare PIN