Provider Demographics
NPI:1447249354
Name:GASTROINTESTINAL ENDOSCOPY CENTER
Entity type:Organization
Organization Name:GASTROINTESTINAL ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORP
Authorized Official - Prefix:
Authorized Official - First Name:REED
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-355-1234
Mailing Address - Street 1:1405 N STATE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1642
Mailing Address - Country:US
Mailing Address - Phone:601-355-1234
Mailing Address - Fax:601-354-3881
Practice Address - Street 1:1405 N STATE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1642
Practice Address - Country:US
Practice Address - Phone:601-355-1234
Practice Address - Fax:601-354-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAXPAYER ID NUMBER