Provider Demographics
NPI:1790790277
Name:ADVANCED GASTROENTEROLOGY HEALTH CARE CENTERS
Entity Type:Organization
Organization Name:ADVANCED GASTROENTEROLOGY HEALTH CARE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNERS
Authorized Official - Prefix:DR
Authorized Official - First Name:SAUD
Authorized Official - Middle Name:ELSAYED
Authorized Official - Last Name:SULEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-763-4920
Mailing Address - Street 1:1690 DUNLAWTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-8980
Mailing Address - Country:US
Mailing Address - Phone:386-763-4920
Mailing Address - Fax:386-763-4939
Practice Address - Street 1:1690 DUNLAWTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-8980
Practice Address - Country:US
Practice Address - Phone:386-763-4920
Practice Address - Fax:386-763-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267121200Medicaid
FL45571OtherBCBS
FL267121200Medicaid