Provider Demographics
NPI:1477687242
Name:GASTROINTESTINAL HEALTHCARE PA
Entity type:Organization
Organization Name:GASTROINTESTINAL HEALTHCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLL O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-870-1352
Mailing Address - Street 1:2011 FALLS VALLEY DR
Mailing Address - Street 2:STE 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3451
Mailing Address - Country:US
Mailing Address - Phone:919-870-1311
Mailing Address - Fax:919-881-0822
Practice Address - Street 1:2011 FALLS VALLEY DR
Practice Address - Street 2:STE 106
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3451
Practice Address - Country:US
Practice Address - Phone:919-881-0743
Practice Address - Fax:919-881-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017VUOtherBCBS
NC2240794OtherCIGNA
NC2638747OtherUNITED HEALTHCARE