Provider Demographics
NPI:1376529008
Name:GASTROENTEROLOGY CARE CENTER
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-913-0688
Mailing Address - Street 1:7500 SW 87TH AVE
Mailing Address - Street 2:200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5426
Mailing Address - Country:US
Mailing Address - Phone:305-913-0666
Mailing Address - Fax:305-913-0664
Practice Address - Street 1:7500 SW 87TH AVE
Practice Address - Street 2:200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5426
Practice Address - Country:US
Practice Address - Phone:305-913-0666
Practice Address - Fax:305-913-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33939Medicare ID - Type Unspecified