MEDICARE: MID-SOUTH GASTROENTEROLOGY ASSOC PC

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1770718405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-SOUTH GASTROENTEROLOGY ASSOC PC

Provider Business Mailing Address
First Line	:	PO BOX 131149
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35213-6149
Country	:	US
Telephone Number	:	877-319-7141
Fax Number	:	877-243-2920

Provider Business Practice Location Address
First Line	:	1510 1/2 HATCHER LN
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-4825
Country	:	US
Telephone Number	:	931-381-7818
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN CORP
Name	:	AMIT A CHOKSI
Credential	:	MD
Telephone Number	:	931-388-8302

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	09/15/2011

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