Basic Information
| Provider Information | |||||||||
| NPI: | 1942620463 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GASTROENTEROLOGY AND HEPATOLOGY MEDICAL ASSOCIATES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GASTROENTEROLOGY AND HEPATOLOGY MEDICAL ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4060 FOURTH AVE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192912687 | ||||||||
| FaxNumber: | 6192913492 | ||||||||
| Practice Location | |||||||||
| Address1: | 4060 FOURTH AVE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192912687 | ||||||||
| FaxNumber: | 6192913492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2014 | ||||||||
| LastUpdateDate: | 04/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | GAIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6192912687 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | Y | Managed Care Organizations | Exclusive Provider Organization |
No ID Information.