Provider Demographics
NPI:1386836070
Name:LIVER AND GASTROENTEROLOGY CENTER
Entity Type:Organization
Organization Name:LIVER AND GASTROENTEROLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHILIPPOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-697-0621
Mailing Address - Street 1:725 GLENWOOD DR
Mailing Address - Street 2:MEMORIAL MEDICAL BLDG EAST SUITE 488E
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1163
Mailing Address - Country:US
Mailing Address - Phone:423-697-0621
Mailing Address - Fax:423-697-8716
Practice Address - Street 1:725 GLENWOOD DR
Practice Address - Street 2:MEMORIAL MEDICAL BLDG EAST SUITE 488E
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1163
Practice Address - Country:US
Practice Address - Phone:423-697-0621
Practice Address - Fax:423-697-8716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729311Medicare PIN