Provider Demographics
NPI:1720170319
Name:GASTROINTESTINAL CONSULTANTS INC
Entity Type:Organization
Organization Name:GASTROINTESTINAL CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEIB JR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-535-2511
Mailing Address - Street 1:350 SOUTHMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-2818
Mailing Address - Country:US
Mailing Address - Phone:814-535-2511
Mailing Address - Fax:814-535-8473
Practice Address - Street 1:350 SOUTHMONT BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2818
Practice Address - Country:US
Practice Address - Phone:814-535-2511
Practice Address - Fax:814-535-8473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006437800002Medicaid
PA091720OtherBLUE SHIELD
PAMEDPLUSOtherMEDPLUS
PA0006437800002Medicaid
PAMEDPLUSOtherMEDPLUS