Provider Demographics
NPI:1508069543
Name:GASTROINTESTINAL SPECIALISTS,PC
Entity Type:Organization
Organization Name:GASTROINTESTINAL SPECIALISTS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORANCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-882-2703
Mailing Address - Street 1:1813 WILLOW ST
Mailing Address - Street 2:SUITE 5 B
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-4267
Mailing Address - Country:US
Mailing Address - Phone:812-882-2703
Mailing Address - Fax:812-882-2760
Practice Address - Street 1:1813 WILLOW ST
Practice Address - Street 2:SUITE 5 B
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-4267
Practice Address - Country:US
Practice Address - Phone:812-882-2703
Practice Address - Fax:812-882-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000873207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100156710AMedicaid
INC24996Medicare UPIN
IN444170AMedicare ID - Type UnspecifiedRICHARD WALTER
IN100156710AMedicaid