Healthcare Provider Details

I. General information

NPI: 1508844374
Provider Name (Legal Business Name): GASTROENTEROLOGISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 8TH AVE SE
CEDAR RAPIDS IA
52401-2121
US

IV. Provider business mailing address

931 8TH AVE SE
CEDAR RAPIDS IA
52401-2121
US

V. Phone/Fax

Practice location:
  • Phone: 319-366-8695
  • Fax: 319-366-0795
Mailing address:
  • Phone: 319-366-8695
  • Fax: 319-366-0795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0271742
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MRS. PAT S CONVEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 319-366-8695