Healthcare Provider Details

I. General information

NPI: 1144454703
Provider Name (Legal Business Name): WEST CENTRAL GASTROENTEROLOGY LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 EXECUTIVE DR SUITE 130
CLEARWATER FL
33762-5323
US

IV. Provider business mailing address

3001 EXECUTIVE DR SUITE 130
CLEARWATER FL
33762-5323
US

V. Phone/Fax

Practice location:
  • Phone: 727-347-0005
  • Fax:
Mailing address:
  • Phone: 727-347-0005
  • Fax: 727-541-6558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND7225
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberME68156
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberOS4755
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: RACHEL PARR
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 727-329-3371