Provider Demographics
NPI:1811998891
Name:CENTER FOR ADVANCED GASTROENTEROLOGY LLC
Entity type:Organization
Organization Name:CENTER FOR ADVANCED GASTROENTEROLOGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:407-644-4222
Mailing Address - Street 1:260 LOOKOUT PL
Mailing Address - Street 2:STE 201
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4485
Mailing Address - Country:US
Mailing Address - Phone:407-644-4014
Mailing Address - Fax:407-644-5270
Practice Address - Street 1:260 LOOKOUT PL
Practice Address - Street 2:STE 201
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4485
Practice Address - Country:US
Practice Address - Phone:407-644-4014
Practice Address - Fax:407-644-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271940100Medicaid
FL74539OtherBCBS GROUP PIN
FL271940100Medicaid