Provider Demographics
NPI:1619965266
Name:ASSOCIATED GASTROENTEROLOGY CONSULTANTS, INC.
Entity Type:Organization
Organization Name:ASSOCIATED GASTROENTEROLOGY CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-875-7666
Mailing Address - Street 1:530 PARK AVE E
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-3901
Mailing Address - Country:US
Mailing Address - Phone:815-875-8666
Mailing Address - Fax:815-872-0487
Practice Address - Street 1:530 PARK AVE E
Practice Address - Street 2:SUITE 207
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-3901
Practice Address - Country:US
Practice Address - Phone:815-875-8666
Practice Address - Fax:815-872-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062499207RG0100X
IL036085799207RG0100X
IL209005803207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
366900Medicare PIN