1568442747 NPI number — GASTROENTEROLOGY AND HEPATOLOGY SPECIALISTS INC.

Table of content: (NPI 1568442747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568442747 NPI number — GASTROENTEROLOGY AND HEPATOLOGY SPECIALISTS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGY AND HEPATOLOGY SPECIALISTS 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:
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:
1568442747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 GERMANTOWN CT STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORDOVA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38018-4258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
330-305-9090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4360 FULTON DR NW
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44718-2878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-305-2020
Provider Business Practice Location Address Fax Number:
330-305-9090
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JUDY
Authorized Official First Name:
AIMEE
Authorized Official Middle Name:
CATHLEEN
Authorized Official Title or Position:
DIRECTOR, CREDENTIALING
Authorized Official Telephone Number:
901-737-4665

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: 2052559 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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