Healthcare Provider Details

I. General information

NPI: 1144218512
Provider Name (Legal Business Name): GASTROENTEROLOGY CONSULTANTS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 RYLAND ST
RENO NV
89502-1603
US

IV. Provider business mailing address

PO BOX 842664
LOS ANGELES CA
90084-2664
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-4600
  • Fax: 775-329-4992
Mailing address:
  • Phone: 775-329-4600
  • Fax: 775-324-4314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number050929200530225
License Number StateNV

VIII. Authorized Official

Name: MR. ERIC OSGARD
Title or Position: DIRECTOR
Credential: MD
Phone: 775-329-4600