Basic Information
| Provider Information | |||||||||
| NPI: | 1881636207 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROENTEROLOGY CONSULTANTS OF GREATER CINCINNATI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10600 MONTGOMERY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452424463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137945600 | ||||||||
| FaxNumber: | 5132811908 | ||||||||
| Practice Location | |||||||||
| Address1: | 10600 MONTGOMERY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452424463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137945600 | ||||||||
| FaxNumber: | 5132811908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 08/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | PECK | ||||||||
| AuthorizedOfficialFirstName: | ALLAN | ||||||||
| AuthorizedOfficialMiddleName: | LAWRENCE | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5137945600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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 | 0968412 | 05 | OH | MEDICAID | 200010970A | 05 | IN | MEDICAID | CB8043 | 01 | MEDICARE RAILROAD | OTHER |