Provider Demographics
NPI:1861654741
Name:EAST BANK GASTROENTEROLOGY, LLC
Entity Type:Organization
Organization Name:EAST BANK GASTROENTEROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARRILLEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-456-7484
Mailing Address - Street 1:PO BOX 8447
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70011-8447
Mailing Address - Country:US
Mailing Address - Phone:504-835-5115
Mailing Address - Fax:504-833-9488
Practice Address - Street 1:501 RUE DE SANTE
Practice Address - Street 2:SUITE 5
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5400
Practice Address - Country:US
Practice Address - Phone:985-652-1126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C417Medicare PIN