Provider Demographics
NPI:1124087028
Name:GASTROINTESTINAL CONSULTANTS, INC
Entity type:Organization
Organization Name:GASTROINTESTINAL CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-388-8878
Mailing Address - Street 1:102 THOMAS RD
Mailing Address - Street 2:SUITE 506
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5550
Mailing Address - Country:US
Mailing Address - Phone:318-388-8878
Mailing Address - Fax:318-388-8870
Practice Address - Street 1:102 THOMAS RD
Practice Address - Street 2:SUITE 506
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5550
Practice Address - Country:US
Practice Address - Phone:318-388-8878
Practice Address - Fax:318-388-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0600001048207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5D860Medicare PIN