Provider Demographics
NPI:1205885324
Name:COLUMBIA GASTROENTEROLOGY & LIVER ASSOCIATES, LLC
Entity type:Organization
Organization Name:COLUMBIA GASTROENTEROLOGY & LIVER ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-449-8680
Mailing Address - Street 1:1605 E BROADWAY
Mailing Address - Street 2:STE 250
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8023
Mailing Address - Country:US
Mailing Address - Phone:573-449-8680
Mailing Address - Fax:573-449-8684
Practice Address - Street 1:1605 E BROADWAY
Practice Address - Street 2:SUITE 250
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8023
Practice Address - Country:US
Practice Address - Phone:573-449-8680
Practice Address - Fax:573-449-8684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4206923OtherAETNA
MOTRICAREOtherTRICARE
MO126589OtherHEALTHLINK
MO194002OtherBLUE CROSS BLUE SHIELD
MO228719OtherGROUP HEALTH PLANS
MO514183OtherPRIVATE HEALTH CARE SYS.
MO1732416OtherFIRST HEALTH
MO3089254005OtherCIGNA