Provider Demographics
NPI:1942620463
Name:GASTROENTEROLOGY AND HEPATOLOGY MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:GASTROENTEROLOGY AND HEPATOLOGY MEDICAL ASSOCIATES
Other - Org Name:GASTROENTEROLOGY AND HEPATOLOGY MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-291-2687
Mailing Address - Street 1:4060 FOURTH AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2116
Mailing Address - Country:US
Mailing Address - Phone:619-291-2687
Mailing Address - Fax:619-291-3492
Practice Address - Street 1:4060 FOURTH AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2116
Practice Address - Country:US
Practice Address - Phone:619-291-2687
Practice Address - Fax:619-291-3492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization