Provider Demographics
NPI:1245339522
Name:NORTHWEST GASTROENTEROLOGY ASSOCIATES P.A.
Entity type:Organization
Organization Name:NORTHWEST GASTROENTEROLOGY ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LASKOSKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-392-5558
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77001-0054
Mailing Address - Country:US
Mailing Address - Phone:281-357-8882
Mailing Address - Fax:281-357-8886
Practice Address - Street 1:425 HOLDERRIETH BLVD
Practice Address - Street 2:STE. 109
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4543
Practice Address - Country:US
Practice Address - Phone:281-357-8882
Practice Address - Fax:281-357-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3640207RG0100X
TXJ2958207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00321ZMedicare ID - Type UnspecifiedMEDICARE