Provider Demographics
NPI:1598229593
Name:TRI-CITY GASTROENTEROLOGY PLC
Entity Type:Organization
Organization Name:TRI-CITY GASTROENTEROLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHING ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-445-4066
Mailing Address - Street 1:PO BOX 30444
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-0444
Mailing Address - Country:US
Mailing Address - Phone:928-266-0118
Mailing Address - Fax:
Practice Address - Street 1:5350 DISTINCTION WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-8418
Practice Address - Country:US
Practice Address - Phone:928-445-4066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0732200OtherBCBS
AZ769789Medicaid