Provider Demographics
NPI:1316589708
Name:GASTROENTEROLOGY OF THE FOUR STATES,LLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY OF THE FOUR STATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SINNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-222-3434
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-4439
Mailing Address - Country:US
Mailing Address - Phone:417-214-0034
Mailing Address - Fax:417-222-3435
Practice Address - Street 1:2024 S MAIDEN LN STE 204
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-0319
Practice Address - Country:US
Practice Address - Phone:417-222-3434
Practice Address - Fax:417-222-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty