Provider Demographics
NPI:1851763510
Name:GASTROCARE OF EL PASO
Entity Type:Organization
Organization Name:GASTROCARE OF EL PASO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IKENNA
Authorized Official - Middle Name:I
Authorized Official - Last Name:EGBUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-702-0165
Mailing Address - Street 1:3270 JOE BATTLE BLVD
Mailing Address - Street 2:STE 245
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2639
Mailing Address - Country:US
Mailing Address - Phone:915-702-0165
Mailing Address - Fax:915-702-0167
Practice Address - Street 1:3270 JOE BATTLE BLVD
Practice Address - Street 2:STE 245
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2639
Practice Address - Country:US
Practice Address - Phone:915-702-0165
Practice Address - Fax:915-702-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty