Provider Demographics
NPI:1306016522
Name:GASTROENTEROLOGY ASSOCIATES OF SWLA LLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF SWLA LLC
Other - Org Name:GI ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-439-0762
Mailing Address - Street 1:555 DR. MICHAEL DEBAKEY DR.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-439-0762
Mailing Address - Fax:337-436-8862
Practice Address - Street 1:555 DR. MICHAEL DEBAKEY DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-439-0762
Practice Address - Fax:337-436-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty