1205885324 NPI number — COLUMBIA GASTROENTEROLOGY & LIVER ASSOCIATES, LLC

Table of content: (NPI 1205885324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205885324 NPI number — COLUMBIA GASTROENTEROLOGY & LIVER ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA GASTROENTEROLOGY & LIVER ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205885324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 E BROADWAY
Provider Second Line Business Mailing Address:
STE 250
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65201-8023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-449-8680
Provider Business Mailing Address Fax Number:
573-449-8684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 E BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65201-8023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-449-8680
Provider Business Practice Location Address Fax Number:
573-449-8684
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
573-449-8680

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4206923 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: TRICARE . This is a "TRICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 126589 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 194002 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 228719 . This is a "GROUP HEALTH PLANS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 514183 . This is a "PRIVATE HEALTH CARE SYS." identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1732416 . This is a "FIRST HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 3089254005 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com