Healthcare Provider Details

I. General information

NPI: 1477519056
Provider Name (Legal Business Name): TEXARKANA GASTROENTEROLOGY CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 05/07/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MOORES LN SUITE A
TEXARKANA TX
75503-4610
US

IV. Provider business mailing address

1920 MOORES LN STE A
TEXARKANA TX
75503-4660
US

V. Phone/Fax

Practice location:
  • Phone: 903-792-8030
  • Fax:
Mailing address:
  • Phone: 903-792-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MARY PRITCHARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-792-8030