Provider Demographics
NPI:1548234289
Name:GASTROENTEROLOGY CONSULTANTS MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CONSULTANTS MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-423-2123
Mailing Address - Street 1:8120 TIMBERLAKE WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5412
Mailing Address - Country:US
Mailing Address - Phone:916-423-2124
Mailing Address - Fax:916-423-2127
Practice Address - Street 1:8120 TIMBERLAKE WAY
Practice Address - Street 2:STE 101
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5412
Practice Address - Country:US
Practice Address - Phone:916-423-2124
Practice Address - Fax:916-423-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 5539207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80876ZMedicaid
CACP6115OtherRAILROAD MEDICARE
CAZZZ80876ZMedicare ID - Type UnspecifiedMEDICAL OFFICE