Healthcare Provider Details

I. General information

NPI: 1265408900
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOCIATES OF HAZARD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR SUITE 2B
HAZARD KY
41701-9466
US

IV. Provider business mailing address

200 MEDICAL CENTER DR SUITE 2B
HAZARD KY
41701-9466
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-3952
  • Fax: 606-439-0154
Mailing address:
  • Phone: 606-439-3952
  • Fax: 606-439-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHARMILA SHANKAR
Title or Position: PRACTICE MANAGER
Credential:
Phone: 606-439-3952