Healthcare Provider Details

I. General information

NPI: 1821014473
Provider Name (Legal Business Name): MGA GASTROINTESTINAL DIAGNOSTIC & THERAPEUTIC-METAIRIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 KINGMAN ST 202
METAIRIE LA
70006-4236
US

IV. Provider business mailing address

PO BOX 121
MARRERO LA
70073-0121
US

V. Phone/Fax

Practice location:
  • Phone: 504-885-3345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER A HOLDEN
Title or Position: CHIEF MANAGER OF LLC
Credential:
Phone: 615-665-1283