Healthcare Provider Details

I. General information

NPI: 1639852189
Provider Name (Legal Business Name): GASTROMEDCONNECT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 KOHLERS CROSSING STE 455
KYLE TX
78640-2464
US

IV. Provider business mailing address

115 KOHLERS CROSSING STE 455
KYLE TX
78640
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-5911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAMI ADIB
Title or Position: MD/OWNER
Credential: MD
Phone: 512-454-5911