1578563813 NPI number — COLON LIVER GASTRO CONSULTANTS PLLC

Table of content: (NPI 1578563813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578563813 NPI number — COLON LIVER GASTRO CONSULTANTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLON LIVER GASTRO CONSULTANTS PLLC
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:
1578563813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 711115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77271-1115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-667-7355
Provider Business Mailing Address Fax Number:
281-565-2009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16651 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
SUITE 370
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-2345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-667-7355
Provider Business Practice Location Address Fax Number:
281-565-2009
Provider Enumeration Date:
07/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GAJULA
Authorized Official First Name:
LEKA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
832-667-7355

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 168610701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".