Provider Demographics
NPI:1528182664
Name:MIDLANDS GASTROENTEROLOGY,P.C.
Entity Type:Organization
Organization Name:MIDLANDS GASTROENTEROLOGY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BALBIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:MINHAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-732-8632
Mailing Address - Street 1:ONE WELLNESS BLVD.
Mailing Address - Street 2:SUITE #110
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2872
Mailing Address - Country:US
Mailing Address - Phone:803-732-8632
Mailing Address - Fax:803-732-8658
Practice Address - Street 1:1 WELLNESS BLVD
Practice Address - Street 2:SUITE #110
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2872
Practice Address - Country:US
Practice Address - Phone:803-732-8632
Practice Address - Fax:803-732-8658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20-20662174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCA241OtherMEDICARE PTAN
SC206627Medicaid
SC206627Medicaid