Provider Demographics
NPI:1134325921
Name:GASTROENTEROLOGY ASSOC PA
Entity type:Organization
Organization Name:GASTROENTEROLOGY ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-771-9920
Mailing Address - Street 1:5301 N DIXIE HWY
Mailing Address - Street 2:STE 202
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3403
Mailing Address - Country:US
Mailing Address - Phone:954-771-9920
Mailing Address - Fax:954-771-9922
Practice Address - Street 1:5301 N DIXIE HWY
Practice Address - Street 2:STE 202
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3403
Practice Address - Country:US
Practice Address - Phone:954-771-9920
Practice Address - Fax:954-771-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL72682Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER