1437336211 NPI number — PANHANDLE GASTROENTEROLOGY, PA

Table of content: (NPI 1437336211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437336211 NPI number — PANHANDLE GASTROENTEROLOGY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PANHANDLE GASTROENTEROLOGY, PA
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:
1437336211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50537
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79159-0537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-354-9400
Provider Business Mailing Address Fax Number:
806-354-9403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 QUAIL CREEK DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79124-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-354-9400
Provider Business Practice Location Address Fax Number:
806-354-9403
Provider Enumeration Date:
01/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BANWAIT
Authorized Official First Name:
KULDIP
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
806-354-9400

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  M4993 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: M4993 . This is a "PHYSICIAN PERMIT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0031QW . This is a "BCBS PROVIDER GROUP NO." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00Y904 . This is a "MEDICARE GROUP BILLING NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 184296503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7830853 . This is a "AETNA PROVIDER ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DN1508 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00149690 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 197441201 . This is a "MEDICAID GROUP BILLING NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8AW200 . This is a "BCBS PROVIDER NO." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8J2689 . This is a "JO WYATT CLINIC MEDICARE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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