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GASTROENTEROLOGY SPECIALIST PC NPI 1003099904


NPI Information

NPI: 1003099904
Provider Name: GASTROENTEROLOGY SPECIALIST PC
Classification: Internal Medicine - 207RG0100X
Entity Type: Organization

Specialization: Gastroenterology

CLIA Number: 23D1042280

Address:
1179 E PARIS AVE SE STE 200
GRAND RAPIDS, MI
ZIP 49546
Phone: (616) 975-9100
Get Directions

GASTROENTEROLOGY SPECIALIST PC is a gastroenterology internal medicine in Grand Rapids, MI. The provider is an internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. GASTROENTEROLOGY SPECIALIST PC NPI is 1003099904. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1179 E PARIS AVE SE STE 200
GRAND RAPIDS, MI
ZIP 49546-682
Phone: (616) 975-9100
Fax: (616) 975-1161

The provider's authorized official is Diane J Atkinson .
The authorized official title is Manager and has the following contact phone number (616) 975-9100.

The CLIA number assigned to this NPI record is 23D1042280 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/13/2007 and was last updated on 12/13/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207RG0100XInternal MedicineGastroenterologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1ON99550MEDICARE PINMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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