Provider Demographics
NPI:1689163982
Name:PREMIER GASTROENTEROLOGY ASSOCIATES-ANES PLLC
Entity Type:Organization
Organization Name:PREMIER GASTROENTEROLOGY ASSOCIATES-ANES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANGTUACO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-747-2828
Mailing Address - Street 1:1701 CENTERVIEW DR STE 312
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4313
Mailing Address - Country:US
Mailing Address - Phone:501-747-2828
Mailing Address - Fax:
Practice Address - Street 1:10001 LILE DR STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6217
Practice Address - Country:US
Practice Address - Phone:501-747-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER GASTROENTEROLOGY ASSOCIATES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-02
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty