Provider Demographics
NPI:1700263423
Name:GASTROENTEROLOGY ASSOCIATES OF CENTRAL TEXAS
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF CENTRAL TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MASI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-222-5673
Mailing Address - Street 1:12414 ALDERBROOK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2596
Mailing Address - Country:US
Mailing Address - Phone:512-222-5673
Mailing Address - Fax:512-717-7270
Practice Address - Street 1:12414 ALDERBROOK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2596
Practice Address - Country:US
Practice Address - Phone:512-222-5673
Practice Address - Fax:512-717-7270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RG0100X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty