Provider Demographics
NPI:1275725673
Name:GASTROENTEROLOGY CONSULTANTS OF TUSCALOOSA INC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CONSULTANTS OF TUSCALOOSA INC
Other - Org Name:TUSCALOOSA ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADISESHA
Authorized Official - Middle Name:BELLAM
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-345-0010
Mailing Address - Street 1:100 RICE MINE RD N
Mailing Address - Street 2:STE E
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2375
Mailing Address - Country:US
Mailing Address - Phone:205-345-0010
Mailing Address - Fax:205-752-1175
Practice Address - Street 1:100 RICE MINE RD N
Practice Address - Street 2:STE E
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2375
Practice Address - Country:US
Practice Address - Phone:205-345-0010
Practice Address - Fax:205-752-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALU6302261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE349OtherMEDICARE GROUP
ALE349OtherMEDICARE GROUP