Provider Demographics
NPI:1538663729
Name:PREMIER GASTROENTEROLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PREMIER GASTROENTEROLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:LOAGAN
Authorized Official - Last Name:ANGTUACO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-747-2828
Mailing Address - Street 1:PO BOX 26618
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-6601
Mailing Address - Country:US
Mailing Address - Phone:501-747-2828
Mailing Address - Fax:501-747-2868
Practice Address - Street 1:10915 N. RODNEY PARHAM
Practice Address - Street 2:SUITE B
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212
Practice Address - Country:US
Practice Address - Phone:501-747-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR228961002Medicaid