Basic Information
| Provider Information | |||||||||
| NPI: | 1528080595 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROENTEROLOGY ASSOCIATES OF NORTH-CENTRAL ALABAMA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 513 BROOKWOOD BLVD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352096862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058700256 | ||||||||
| FaxNumber: | 2058701707 | ||||||||
| Practice Location | |||||||||
| Address1: | 513 BROOKWOOD BLVD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352096862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058700256 | ||||||||
| FaxNumber: | 2058701707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3056327877 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | CM2316 | 01 | RAILROAD MEDICARE | OTHER |