MEDICARE: GASTROENTEROLOGY MEDICAL CLINIC

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	:	1578741401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROENTEROLOGY MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	1580 CREEKSIDE DR STE 150
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3888
Country	:	US
Telephone Number	:	916-983-4444
Fax Number	:	916-983-8563

Provider Business Practice Location Address
First Line	:	1580 CREEKSIDE DR STE 220
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3888
Country	:	US
Telephone Number	:	916-983-4444
Fax Number	:	916-983-8563

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT ERICK PECHA
Credential	:	M.D.
Telephone Number	:	916-983-4444

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	10/18/2023

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Directions to “GASTROENTEROLOGY MEDICAL CLINIC ” Practice Location

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