1003147364 NPI number — GASTROENTEROLOGY INSTITUTE, INC.

Table of content: (NPI 1003147364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003147364 NPI number — GASTROENTEROLOGY INSTITUTE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGY INSTITUTE, INC.
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:
GII
Provider Other Organization Name Type Code:
3
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:
1003147364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4041
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUMA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70361-4041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-868-7773
Provider Business Mailing Address Fax Number:
985-868-4242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 BELANGER ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
HOUMA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70360-4463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-868-7773
Provider Business Practice Location Address Fax Number:
985-868-4242
Provider Enumeration Date:
01/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MOUSSA
Authorized Official First Name:
KHALID
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
985-868-7773

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  201030 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1099058 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1922116631 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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