Provider Demographics
NPI:1639260763
Name:CENTRAL TEXAS DIGESTIVE DISEASE ASSOCIATION, PA
Entity Type:Organization
Organization Name:CENTRAL TEXAS DIGESTIVE DISEASE ASSOCIATION, PA
Other - Org Name:CENTRAL TEXAS GASTROENTEROLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MSN, RN
Authorized Official - Phone:979-776-4600
Mailing Address - Street 1:2206 E VILLA MARIA RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2547
Mailing Address - Country:US
Mailing Address - Phone:979-776-4600
Mailing Address - Fax:979-774-0877
Practice Address - Street 1:2206 E VILLA MARIA RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2547
Practice Address - Country:US
Practice Address - Phone:979-776-4600
Practice Address - Fax:979-774-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T59ZMedicare ID - Type Unspecified