Provider Demographics
NPI:1407928641
Name:SIERRA NEVADA GASTROENTEROLOGY MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SIERRA NEVADA GASTROENTEROLOGY MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-273-3377
Mailing Address - Street 1:300 SIERRA COLLEGE DR
Mailing Address - Street 2:STE.105
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5082
Mailing Address - Country:US
Mailing Address - Phone:530-273-3377
Mailing Address - Fax:530-273-3387
Practice Address - Street 1:300 SIERRA COLLEGE DR
Practice Address - Street 2:STE.105
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5082
Practice Address - Country:US
Practice Address - Phone:530-273-3377
Practice Address - Fax:530-273-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22428ZMedicare ID - Type Unspecified