Provider Demographics
NPI:1417930447
Name:ALEXANDRIA GASTROENTEROLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:ALEXANDRIA GASTROENTEROLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF ORGANIZATION MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DRAKE
Authorized Official - Last Name:HOLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-473-8188
Mailing Address - Street 1:301 4TH ST
Mailing Address - Street 2:BOX 30146
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301
Mailing Address - Country:US
Mailing Address - Phone:318-473-8188
Mailing Address - Fax:318-473-8682
Practice Address - Street 1:301 4TH ST
Practice Address - Street 2:SUITE 1-A
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8423
Practice Address - Country:US
Practice Address - Phone:318-473-8188
Practice Address - Fax:318-473-8682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACN3551OtherMEDICARE ID
LA43127OtherBLUE CROSS BLUE SHEILD GR
LA1799696Medicaid
LACN3551OtherMEDICARE ID