Provider Demographics
NPI:1578106621
Name:FAIRHOPE GASTROENTEROLOGY, LLC
Entity Type:Organization
Organization Name:FAIRHOPE GASTROENTEROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:IVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-928-8804
Mailing Address - Street 1:3 MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1804
Mailing Address - Country:US
Mailing Address - Phone:251-928-8804
Mailing Address - Fax:251-990-9379
Practice Address - Street 1:3 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1804
Practice Address - Country:US
Practice Address - Phone:251-928-8804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty