Provider Demographics
NPI:1326004839
Name:CONSULTANTS IN GASTROENTEROLOGY PA
Entity Type:Organization
Organization Name:CONSULTANTS IN GASTROENTEROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEINZELMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-794-4585
Mailing Address - Street 1:131 SUMMERPLACE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3058
Mailing Address - Country:US
Mailing Address - Phone:803-794-4585
Mailing Address - Fax:803-796-8924
Practice Address - Street 1:131 SUMMERPLACE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3058
Practice Address - Country:US
Practice Address - Phone:803-794-4585
Practice Address - Fax:803-796-8924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0373Medicaid
SC3946Medicare PIN