Basic Information
| Provider Information | |||||||||
| NPI: | 1932228137 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROENTEROLOGY ASSOCIATES OF CENTRAL KY PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 S 2ND ST | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404221804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592365302 | ||||||||
| FaxNumber: | 8592365025 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 S 2ND ST | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404221804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592365302 | ||||||||
| FaxNumber: | 8592365025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 01/22/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 12/03/2007 | ||||||||
| NPIReactivationDate: | 01/22/2008 | ||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SPURLIN | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8592365302 | ||||||||
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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 | 65932238 | 05 | KY | MEDICAID |