Provider Demographics
NPI:1477605939
Name:GASTROENTEROLOGY ASSOC. OF SARASOTA
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOC. OF SARASOTA
Other - Org Name:FDHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-556-1415
Mailing Address - Street 1:2089 HAWTHORNE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2308
Mailing Address - Country:US
Mailing Address - Phone:941-365-6556
Mailing Address - Fax:941-365-6678
Practice Address - Street 1:2089 HAWTHORNE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2308
Practice Address - Country:US
Practice Address - Phone:941-365-6556
Practice Address - Fax:941-365-6678
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA DIGESTIVE HEALTH SPECIALIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-17
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
100003264OtherRAILROAD MEDICARE
100016526OtherRAILROAD MEDICARE
100003263OtherRAILROAD MEDICARE
P00092139OtherRAILROAD MEDICARE
100003263OtherRAILROAD MEDICARE