Provider Demographics
NPI:1417986191
Name:PADUCAH GASTROENTEROLOGY ASSOCIATES, PSC
Entity Type:Organization
Organization Name:PADUCAH GASTROENTEROLOGY ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-443-8285
Mailing Address - Street 1:2605 KENTUCKY AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3800
Mailing Address - Country:US
Mailing Address - Phone:270-443-8285
Mailing Address - Fax:270-442-9543
Practice Address - Street 1:2605 KENTUCKY AVE
Practice Address - Street 2:STE 202
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3800
Practice Address - Country:US
Practice Address - Phone:270-442-8285
Practice Address - Fax:270-442-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2031Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER MED