Provider Demographics
NPI:1801994157
Name:CENTERS FOR GASTROENTEROLOGY
Entity type:Organization
Organization Name:CENTERS FOR GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDDOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-212-0879
Mailing Address - Street 1:3702 S TIMBERLINE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3624
Mailing Address - Country:US
Mailing Address - Phone:970-207-9773
Mailing Address - Fax:970-207-1893
Practice Address - Street 1:3702 S TIMBERLINE RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3624
Practice Address - Country:US
Practice Address - Phone:970-207-9773
Practice Address - Fax:970-207-1893
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTERS FOR GASTROENTEROLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04006219Medicaid
COCS9815OtherMEDICARE RAILROAD PIN
CO04006219Medicaid
WYW308193Medicare PIN
CO04006219Medicaid