Basic Information
| Provider Information | |||||||||
| NPI: | 1093263519 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIOGASTREX, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | EXCELSIOR ANESTHESIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 RICE MINE RD N | ||||||||
| Address2: | SUITE E | ||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354062300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053450010 | ||||||||
| FaxNumber: | 2057521175 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 RICE MINE RD N | ||||||||
| Address2: | SUITE E | ||||||||
| City: | TUSCALOOSA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354062300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053450010 | ||||||||
| FaxNumber: | 2057521175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2016 | ||||||||
| LastUpdateDate: | 09/15/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | REDDY | ||||||||
| AuthorizedOfficialFirstName: | ADISESHA | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2053450010 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.