1942207907 NPI number — GASTROINTESTINAL HEALTH ASSOCIATES

Table of content: (NPI 1942207907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942207907 NPI number — GASTROINTESTINAL HEALTH ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROINTESTINAL HEALTH ASSOCIATES
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:
1942207907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 RANDALL RD
Provider Second Line Business Mailing Address:
SUITE 308
Provider Business Mailing Address City Name:
GENEVA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60134-4209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-208-7388
Provider Business Mailing Address Fax Number:
630-208-4818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 RANDALL RD
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
GENEVA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60134-4209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-208-7388
Provider Business Practice Location Address Fax Number:
630-208-4818
Provider Enumeration Date:
07/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
630-208-7388

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  0055909-1 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CK6933 . This is a "RR MEDICARE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4532084 . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com