Provider Demographics
NPI:1760467732
Name:G I DIAGNOSTIC AND THERAPEUTIC CENTER LLC
Entity Type:Organization
Organization Name:G I DIAGNOSTIC AND THERAPEUTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-937-6073
Mailing Address - Street 1:1310 WOLF PARK DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1741
Mailing Address - Country:US
Mailing Address - Phone:901-624-5151
Mailing Address - Fax:901-624-5280
Practice Address - Street 1:1310 WOLF PARK DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1741
Practice Address - Country:US
Practice Address - Phone:901-624-5151
Practice Address - Fax:901-624-5280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000041261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3287369Medicare ID - Type Unspecified