Provider Demographics
NPI:1295731354
Name:EAST BANK GASTROENTEROLOGY LLC
Entity type:Organization
Organization Name:EAST BANK GASTROENTEROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:N
Authorized Official - Last Name:BARRILLEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-456-7484
Mailing Address - Street 1:PO BOX 8447
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70011-8447
Mailing Address - Country:US
Mailing Address - Phone:504-835-5115
Mailing Address - Fax:504-833-9480
Practice Address - Street 1:3800 HOUMA BLVD
Practice Address - Street 2:STE 220
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4151
Practice Address - Country:US
Practice Address - Phone:504-456-7484
Practice Address - Fax:504-456-6829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA410437207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1948811Medicaid
LA1948811Medicaid
LA5C417Medicare PIN
LA5C041Medicare PIN