Provider Demographics
NPI:1578321758
Name:MODERN GASTROENTEROLOGY, LLC
Entity Type:Organization
Organization Name:MODERN GASTROENTEROLOGY, LLC
Other - Org Name:MODERN GASTROENTEROLOGY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSSEINI-ASLINIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS
Authorized Official - Phone:209-814-3400
Mailing Address - Street 1:15444 IRON HORSE CIR
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3852
Mailing Address - Country:US
Mailing Address - Phone:209-814-3400
Mailing Address - Fax:949-695-4386
Practice Address - Street 1:9393 W 110TH ST STE 500
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1464
Practice Address - Country:US
Practice Address - Phone:913-804-7500
Practice Address - Fax:949-695-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty