Provider Demographics
NPI:1386687762
Name:PEDIATRIC GASTROENTEROLOGY CONSULANTS, PA
Entity Type:Organization
Organization Name:PEDIATRIC GASTROENTEROLOGY CONSULANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALASWAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-813-3883
Mailing Address - Street 1:PO BOX 2183
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77497-2183
Mailing Address - Country:US
Mailing Address - Phone:409-813-3883
Mailing Address - Fax:409-813-3848
Practice Address - Street 1:740 HOSPITAL DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4670
Practice Address - Country:US
Practice Address - Phone:409-813-3883
Practice Address - Fax:409-813-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK05972080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179187301Medicaid
TX=========OtherTAX ID
TXF71709Medicare UPIN
TX179187301Medicaid