Provider Demographics
NPI:1922019793
Name:ENID GASTROENTEROLOGY, INC., P.C.
Entity Type:Organization
Organization Name:ENID GASTROENTEROLOGY, INC., P.C.
Other - Org Name:ENID GASTROENTEROLOGY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANKU
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:582-234-0285
Mailing Address - Street 1:330 S 5TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5825
Mailing Address - Country:US
Mailing Address - Phone:580-234-0285
Mailing Address - Fax:580-234-0590
Practice Address - Street 1:330 S 5TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5825
Practice Address - Country:US
Practice Address - Phone:580-234-0285
Practice Address - Fax:580-234-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12331174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100748230AMedicaid
OK100748230AMedicaid
OKD35171Medicare UPIN