Healthcare Provider Details

I. General information

NPI: 1285030080
Provider Name (Legal Business Name): GREATER MONTGOMERY PATIENT CENTERED GASTROENTEROLOGY AND HEPATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 PINE ST SUITE 801
MONTGOMERY AL
36106-1103
US

IV. Provider business mailing address

1898 MULBERRY ST
MONTGOMERY AL
36106-1526
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-8000
  • Fax: 334-532-0108
Mailing address:
  • Phone: 334-239-7059
  • Fax: 334-239-7841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberDO.1453
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIPLOVE SENADHI
Title or Position: CEO
Credential: DO
Phone: 215-740-0034