Provider Demographics
NPI:1538128277
Name:TRI-CITIES GASTROENTEROLOGY, PC
Entity Type:Organization
Organization Name:TRI-CITIES GASTROENTEROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEMITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-681-0556
Mailing Address - Street 1:1714 E HUNDRED RD.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-3310
Mailing Address - Country:US
Mailing Address - Phone:804-681-0556
Mailing Address - Fax:804-681-0553
Practice Address - Street 1:1714. E. HUNDRED RD.
Practice Address - Street 2:SUITE 104
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-3310
Practice Address - Country:US
Practice Address - Phone:804-681-0556
Practice Address - Fax:804-681-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG44660Medicare UPIN
VAC08975Medicare PIN