Provider Demographics
NPI:1447234919
Name:GENGASTRO LLC
Entity Type:Organization
Organization Name:GENGASTRO LLC
Other - Org Name:ENDOSCOPY CENTER FOR DIGESTIVE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD INSURANCE BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-383-2686
Mailing Address - Street 1:2222 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7546
Mailing Address - Country:US
Mailing Address - Phone:563-383-2686
Mailing Address - Fax:563-884-8144
Practice Address - Street 1:2222 53RD AVE
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7546
Practice Address - Country:US
Practice Address - Phone:563-383-2686
Practice Address - Fax:563-884-8144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA261QA1903X, 261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1603165OtherCSA
IA0610279Medicaid
IA0610279Medicaid
BG865037OtherDEA
IA0610279Medicaid