Healthcare Provider Details

I. General information

NPI: 1083872600
Provider Name (Legal Business Name): GASTRO CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 SE 12TH ST STE 200
OCALA FL
34471-3774
US

IV. Provider business mailing address

316 SE 12TH ST STE 200
OCALA FL
34471-3774
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-1919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CANDY ANN PAQUETTE
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-401-1919