Provider Demographics
NPI:1821298225
Name:GASTROENTEROLOGY CONSULTANTS OF SAN ANTONIO, P.A.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CONSULTANTS OF SAN ANTONIO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIRL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-1234
Mailing Address - Street 1:PO BOX 2778
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78299-2778
Mailing Address - Country:US
Mailing Address - Phone:210-614-1234
Mailing Address - Fax:210-614-0952
Practice Address - Street 1:5223 HAMILTON WOLFE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4463
Practice Address - Country:US
Practice Address - Phone:210-614-1234
Practice Address - Fax:210-614-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8981207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8981OtherSTATE LICENSE
TXCJ2572OtherMEDICARE RR
TX00HV34OtherBCBS
TX109472403Medicaid
TX7645694OtherAETNA
TXCJ2572OtherMEDICARE RR