Provider Demographics
NPI:1922080266
Name:COLUMBIA GASTROENTEROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:COLUMBIA GASTROENTEROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGOT
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-799-4800
Mailing Address - Street 1:2739 LAUREL ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2028
Mailing Address - Country:US
Mailing Address - Phone:803-799-4800
Mailing Address - Fax:803-252-0052
Practice Address - Street 1:2739 LAUREL ST
Practice Address - Street 2:SUITE 1-A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2028
Practice Address - Country:US
Practice Address - Phone:803-799-3737
Practice Address - Fax:803-256-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4000Medicare PIN