Basic Information
| Provider Information | |||||||||
| NPI: | 1447249354 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROINTESTINAL ENDOSCOPY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1405 N STATE ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392021642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013551234 | ||||||||
| FaxNumber: | 6013543881 | ||||||||
| Practice Location | |||||||||
| Address1: | 1405 N STATE ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392021642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013551234 | ||||||||
| FaxNumber: | 6013543881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOGAN | ||||||||
| AuthorizedOfficialFirstName: | REED | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OF CORP | ||||||||
| AuthorizedOfficialTelephone: | 6013551234 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | X | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 261Q00000X | X | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.