Provider Demographics
NPI:1508556465
Name:INTERVENTIONAL GASTROENTEROLOGY CONSULTANTS A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:INTERVENTIONAL GASTROENTEROLOGY CONSULTANTS A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-256-4360
Mailing Address - Street 1:4845 VIA DEL CERRO
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-2641
Mailing Address - Country:US
Mailing Address - Phone:714-305-9507
Mailing Address - Fax:888-818-3162
Practice Address - Street 1:4845 VIA DEL CERRO
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-2641
Practice Address - Country:US
Practice Address - Phone:714-305-9507
Practice Address - Fax:888-818-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty