Provider Demographics
NPI:1851473714
Name:JASPER GASTROENTEROLOGY INC.
Entity Type:Organization
Organization Name:JASPER GASTROENTEROLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HARSHAD
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-331-2996
Mailing Address - Street 1:26 GRASSLAND
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2839
Mailing Address - Country:US
Mailing Address - Phone:949-679-2377
Mailing Address - Fax:949-679-2377
Practice Address - Street 1:3400 HIGHWAY 78 E
Practice Address - Street 2:GI CLINIC, WALKER BAPTIST MEDICAL CENTER
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8907
Practice Address - Country:US
Practice Address - Phone:205-387-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18745207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-27446OtherBCBS OF AL
AL76375Medicare ID - Type Unspecified