PREMIER GASTROENTEROLOGY P. C. NPI 1104835461

NPI Information

PREMIER GASTROENTEROLOGY, P. C. is a specialist in Southaven, MS. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. PREMIER GASTROENTEROLOGY, P. C. NPI is 1104835461. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

7900 AIRWAYS BLVD
BLDG A STE 3A
SOUTHAVEN, MS
ZIP 38671-113
Phone: (662) 349-6113
Fax: (662) 349-6188

The provider's authorized official is Tariq A. Khan .
The authorized official title is President and has the following contact phone number (662) 349-6113.

The enumeration date for this NPI number is 8/5/2006 and was last updated on 5/7/2008.

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:

Other Identifiers

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

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