Provider Demographics
NPI:1609235944
Name:ALL GASTRO LTD.
Entity Type:Organization
Organization Name:ALL GASTRO LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FISK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-531-2599
Mailing Address - Street 1:2105 WOODBINE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-2813
Mailing Address - Country:US
Mailing Address - Phone:309-310-6760
Mailing Address - Fax:
Practice Address - Street 1:600 S 13TH ST
Practice Address - Street 2:SUITE J
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4936
Practice Address - Country:US
Practice Address - Phone:309-310-6760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36081816207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty