Provider Demographics
NPI:1780958090
Name:WESTERN GASTROINTESTINAL ASSOC
Entity type:Organization
Organization Name:WESTERN GASTROINTESTINAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGU
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-210-0040
Mailing Address - Street 1:1801 WEST 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644
Mailing Address - Country:US
Mailing Address - Phone:580-210-0040
Mailing Address - Fax:
Practice Address - Street 1:1801 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5145
Practice Address - Country:US
Practice Address - Phone:580-210-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27215207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty