Provider Demographics
NPI:1245272541
Name:GASTROENTEROLOGY GROUP, LLC
Entity type:Organization
Organization Name:GASTROENTEROLOGY GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-871-1721
Mailing Address - Street 1:PO BOX 848778
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8778
Mailing Address - Country:US
Mailing Address - Phone:985-871-1721
Mailing Address - Fax:985-893-6908
Practice Address - Street 1:131 CHEROKEE ROSE LN
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7195
Practice Address - Country:US
Practice Address - Phone:985-871-1721
Practice Address - Fax:985-871-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACG2313OtherMEDICARE RAILROAD
MS09015774Medicaid
MSCK5954OtherMEDICARE RAILROAD
LA1799181Medicaid
LACN9069OtherMEDICARE RAILROAD
LACN9069OtherMEDICARE RAILROAD
MS09015774Medicaid