Healthcare Provider Details

I. General information

NPI: 1932189768
Provider Name (Legal Business Name): CONSULTANTS IN GASTROENTEROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 S WHITNEY AVE SUITE 200
INDEPENDENCE MO
64055-6739
US

IV. Provider business mailing address

17501 E US HIGHWAY 40 SUITE 213A
INDEPENDENCE MO
64055-5442
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4887
  • Fax: 816-478-7140
Mailing address:
  • Phone: 816-478-4887
  • Fax: 816-478-7140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TARA R REYNA
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 816-478-4887