Healthcare Provider Details

I. General information

NPI: 1851391486
Provider Name (Legal Business Name): TRI-COUNTY GASTROENTEROLOGY, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 DUTCHMANS LN STE 601
LOUISVILLE KY
40207-4707
US

IV. Provider business mailing address

2301 RIVER RD STE 300
LOUISVILLE KY
40206-1010
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-7744
  • Fax: 502-893-7741
Mailing address:
  • Phone: 502-814-3175
  • Fax: 502-426-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ARAND GUPTA
Title or Position: OWNER
Credential: M.D.
Phone: 502-893-7744