MEDICARE: CONSULTANTS IN GASTROENTEROLOGY, 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	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	:	1932189768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSULTANTS IN GASTROENTEROLOGY, PC

Provider Business Mailing Address
First Line	:	17501 E US HIGHWAY 40
Second Line	:	SUITE 213A
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-5442
Country	:	US
Telephone Number	:	816-478-4887
Fax Number	:	816-478-7140

Provider Business Practice Location Address
First Line	:	3800 S WHITNEY AVE
Second Line	:	SUITE 200
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6739
Country	:	US
Telephone Number	:	816-478-4887
Fax Number	:	816-478-7140

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	TARA R REYNA
Credential	:
Telephone Number	:	816-478-4887

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	11/02/2011

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