Provider Demographics
NPI:1598482440
Name:GASTROINTESTINAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:GASTROINTESTINAL ASSOCIATES, PA
Other - Org Name:HATTIESBURG GI ASSOCIATES BELLEVUE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-424-2213
Mailing Address - Street 1:2510 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9513
Mailing Address - Country:US
Mailing Address - Phone:601-355-1234
Mailing Address - Fax:601-326-3566
Practice Address - Street 1:7127 HWY 98 W
Practice Address - Street 2:SUITE 10
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7034
Practice Address - Country:US
Practice Address - Phone:601-268-5185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GASTROINTESTINAL ASSOCIATES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-21
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014857Medicaid