Provider Demographics
NPI:1811935067
Name:TRI-STATE GASTROENTEROLOGY P.C.
Entity type:Organization
Organization Name:TRI-STATE GASTROENTEROLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-842-2701
Mailing Address - Street 1:PO BOX 5068
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5068
Mailing Address - Country:US
Mailing Address - Phone:812-842-2701
Mailing Address - Fax:812-842-2717
Practice Address - Street 1:4133 GATEWAY BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7953
Practice Address - Country:US
Practice Address - Phone:812-842-2701
Practice Address - Fax:812-842-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038295207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200073540AMedicaid
IN100180010AMedicaid
100002411OtherRAILROAD MEDICARE
000000042589OtherANTHEM
IL400746743Medicaid
KY64871676Medicaid
IN100180010AMedicaid
IL400746743Medicaid