Healthcare Provider Details

I. General information

NPI: 1255658928
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOCIATES ENDOSCOPY CENTER. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 SONOMA ST
REDDING CA
96001-2519
US

IV. Provider business mailing address

20 BURTON HILLS BLVD SUITE 500
NASHVILLE TN
37215-6197
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-7000
  • Fax:
Mailing address:
  • Phone: 615-240-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILLIP CLENDENIN
Title or Position: PRESIDENT OF LLC
Credential:
Phone: 615-665-1283