Provider Demographics
NPI:1518156397
Name:GASTROENTEROLOGY ASSOCIATES P C
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES P C
Other - Org Name:NORTHWEAT TENNESSEE GASTROENTEROLOGY CONSULTANT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKHIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-587-5170
Mailing Address - Street 1:148 MOUNT PELIA RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3812
Mailing Address - Country:US
Mailing Address - Phone:731-587-5170
Mailing Address - Fax:731-587-5270
Practice Address - Street 1:148 MOUNT PELIA RD
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3812
Practice Address - Country:US
Practice Address - Phone:731-587-5170
Practice Address - Fax:731-587-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD020210174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370162Medicaid
TN3053871OtherBCBS OF TN
TN3370162Medicare PIN