Provider Demographics
NPI:1932228137
Name:GASTROENTEROLOGY ASSOCIATES OF CENTRAL KY PSC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF CENTRAL KY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPURLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-236-5302
Mailing Address - Street 1:212 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1804
Mailing Address - Country:US
Mailing Address - Phone:859-236-5302
Mailing Address - Fax:859-236-5025
Practice Address - Street 1:212 S 2ND ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1804
Practice Address - Country:US
Practice Address - Phone:859-236-5302
Practice Address - Fax:859-236-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-01-22
Deactivation Date:2007-12-03
Deactivation Code:
Reactivation Date:2008-01-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65932238Medicaid
0615502Medicare ID - Type Unspecified
KY65932238Medicaid