Provider Demographics
NPI:1487040192
Name:COLUMBIA GASTROENTEROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:COLUMBIA GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATIVE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGOT
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-799-4800
Mailing Address - Street 1:100 PALMETTO HEALTH PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1753
Mailing Address - Country:US
Mailing Address - Phone:803-907-7600
Mailing Address - Fax:
Practice Address - Street 1:100 PALMETTO HEALTH PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1753
Practice Address - Country:US
Practice Address - Phone:803-907-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19286261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service