Provider Demographics
NPI:1962840686
Name:MISSION GASTROENTEROLOGY GROUP PLLC
Entity Type:Organization
Organization Name:MISSION GASTROENTEROLOGY GROUP PLLC
Other - Org Name:NORRIS GASTROENTEROLOGY GROUP PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-259-5758
Mailing Address - Street 1:3443 DICKERSON PIKE
Mailing Address - Street 2:SUITE 770
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2519
Mailing Address - Country:US
Mailing Address - Phone:615-259-5758
Mailing Address - Fax:615-259-5754
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SUITE 770
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:615-259-5758
Practice Address - Fax:615-259-5754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36718174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty