Provider Demographics
NPI:1780916205
Name:GASTROENTEROLOGY ASSCOAITES OF CENTRAL VA AMBULATORY HEALTH CARE
Entity type:Organization
Organization Name:GASTROENTEROLOGY ASSCOAITES OF CENTRAL VA AMBULATORY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:WISNIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-384-1862
Mailing Address - Street 1:121 NATIONWIDE DR STE B
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4272
Mailing Address - Country:US
Mailing Address - Phone:434-384-1862
Mailing Address - Fax:434-455-8681
Practice Address - Street 1:121 NATIONWIDE DR STE B
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4272
Practice Address - Country:US
Practice Address - Phone:434-384-1862
Practice Address - Fax:434-455-8681
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GASTROENTEROLOGY ASSOCIATES OF CENTRAL VA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-09
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy