Basic Information
| Provider Information | |||||||||
| NPI: | 1386089308 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROENTEROLOGY ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10000 SE MAIN ST STE 112 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972162441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032553054 | ||||||||
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| Practice Location | |||||||||
| Address1: | 417 SE 164TH AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986848944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032553054 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2013 | ||||||||
| LastUpdateDate: | 05/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | KINZER | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO OF ADVENTIST HEALTH CLINICS | ||||||||
| AuthorizedOfficialTelephone: | 5032553054 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.