Provider Demographics
NPI:1538295241
Name:CENTRAL ALABAMA GASTROENTEROLOGY,PC
Entity Type:Organization
Organization Name:CENTRAL ALABAMA GASTROENTEROLOGY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HOLCOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-329-2829
Mailing Address - Street 1:3368 HIGHWAY 280
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3393
Mailing Address - Country:US
Mailing Address - Phone:256-329-2829
Mailing Address - Fax:256-329-9135
Practice Address - Street 1:3368 HIGHWAY 280
Practice Address - Street 2:SUITE 214
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3393
Practice Address - Country:US
Practice Address - Phone:256-329-2829
Practice Address - Fax:256-329-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529603400Medicaid
AL51028627OtherBLUE CROSS BLUE SHIELD
AL529603400Medicaid
AL51028627OtherBLUE CROSS BLUE SHIELD