Provider Demographics
NPI:1437336211
Name:PANHANDLE GASTROENTEROLOGY, PA
Entity Type:Organization
Organization Name:PANHANDLE GASTROENTEROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KULDIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:BANWAIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-354-9400
Mailing Address - Street 1:PO BOX 50537
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-0537
Mailing Address - Country:US
Mailing Address - Phone:806-354-9400
Mailing Address - Fax:806-354-9403
Practice Address - Street 1:800 QUAIL CREEK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1634
Practice Address - Country:US
Practice Address - Phone:806-354-9400
Practice Address - Fax:806-354-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4993207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM4993OtherPHYSICIAN PERMIT
TX0031QWOtherBCBS PROVIDER GROUP NO.
TX00Y904OtherMEDICARE GROUP BILLING NUMBER
TX184296503Medicaid
TX7830853OtherAETNA PROVIDER ID
DN1508OtherRAILROAD MEDICARE
TX00149690OtherDPS
TX197441201OtherMEDICAID GROUP BILLING NUMBER
TX8AW200OtherBCBS PROVIDER NO.
TX8J2689OtherJO WYATT CLINIC MEDICARE NUMBER
TX8J2689OtherJO WYATT CLINIC MEDICARE NUMBER
TXBB6852176OtherDEA