MEDICARE: SOUTHWEST GASTROENTEROLOGY ASSOCIATES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154363893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST GASTROENTEROLOGY ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	80 LANDINGS DR STE 205
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-9408
Country	:	US
Telephone Number	:	724-941-3020
Fax Number	:	724-426-7713

Provider Business Practice Location Address
First Line	:	80 LANDINGS DR STE 205
Second Line	:
City	:	WASHINGTON
State	:	PA
Zip	:	15301-9408
Country	:	US
Telephone Number	:	724-941-3020
Fax Number	:	724-426-7713

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD J PANICCO
Credential	:	D.O.
Telephone Number	:	724-941-3020

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	06/22/2020

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