Provider Demographics
NPI:1598783482
Name:EAST TEXAS GASTROENTEROLOGY ASSOCIATES, P A
Entity Type:Organization
Organization Name:EAST TEXAS GASTROENTEROLOGY ASSOCIATES, P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-236-2222
Mailing Address - Street 1:701 E MARSHALL AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5573
Mailing Address - Country:US
Mailing Address - Phone:903-236-2222
Mailing Address - Fax:
Practice Address - Street 1:701 E MARSHALL AVE
Practice Address - Street 2:STE. 200
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5573
Practice Address - Country:US
Practice Address - Phone:903-236-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B08SMedicare ID - Type Unspecified