Provider Demographics
NPI:1881621027
Name:GASTROENTEROLOGY CONSULTANTS INC
Entity type:Organization
Organization Name:GASTROENTEROLOGY CONSULTANTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIANCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-288-8100
Mailing Address - Street 1:490 NORTHAMPTON ST
Mailing Address - Street 2:GATEWAY SUITE 1
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4551
Mailing Address - Country:US
Mailing Address - Phone:570-288-8100
Mailing Address - Fax:570-288-7987
Practice Address - Street 1:490 NORTHAMPTON ST
Practice Address - Street 2:GATEWAY SUITE 1
Practice Address - City:EDWARDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-4551
Practice Address - Country:US
Practice Address - Phone:570-288-8100
Practice Address - Fax:570-288-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
414537Medicare ID - Type Unspecified