Basic Information
| Provider Information | |||||||||
| NPI: | 1871884700 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST VALLEY GASTROENTEROLOGY & HEPATOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6190 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852466190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807866655 | ||||||||
| FaxNumber: | 4805050764 | ||||||||
| Practice Location | |||||||||
| Address1: | 803 N SALK DR | ||||||||
| Address2: | |||||||||
| City: | CASA GRANDE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851225447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807866655 | ||||||||
| FaxNumber: | 4805050764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2011 | ||||||||
| LastUpdateDate: | 04/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | SINGH | ||||||||
| AuthorizedOfficialFirstName: | SWARNJIT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4807866655 | ||||||||
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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 | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | Z141552 | 01 | AZ | MEDICARE PTAN | OTHER |