1942685409 NPI number — ADVANCED GASTROENTEROLOGY OF TEXAS PLLC

Table of content: (NPI 1942685409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942685409 NPI number — ADVANCED GASTROENTEROLOGY OF TEXAS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED GASTROENTEROLOGY OF TEXAS 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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1942685409
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 801344
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75380-1344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-962-4863
Provider Business Mailing Address Fax Number:
214-758-1400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2698 NORTH GALLOWAY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-962-4863
Provider Business Practice Location Address Fax Number:
214-758-1400
Provider Enumeration Date:
07/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MASROUR
Authorized Official First Name:
FARBOD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-320-7680

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  N9262 , 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)





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