Provider Demographics
NPI:1902822547
Name:METROPOLITAN GASTROENTEROLOGY ASSOCIATES APMC
Entity Type:Organization
Organization Name:METROPOLITAN GASTROENTEROLOGY ASSOCIATES APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAMBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-349-6401
Mailing Address - Street 1:P.O. BOX 1520
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70073-1520
Mailing Address - Country:US
Mailing Address - Phone:504-349-6423
Mailing Address - Fax:504-934-8097
Practice Address - Street 1:1111 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE S-450
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3151
Practice Address - Country:US
Practice Address - Phone:504-349-6423
Practice Address - Fax:504-934-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1794864Medicaid
LA5B740Medicare PIN