=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043337074
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWEST GASTOENTEROLOGY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 911 S STATE HWY 123 BYPASS
-----------------------------------------------------
City | SEGUIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78155-9754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-372-9042
-----------------------------------------------------
Fax | 830-372-2391
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2256
-----------------------------------------------------
City | SEGUIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78156-2256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-372-9042
-----------------------------------------------------
Fax | 830-382-2391
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TONY N TSEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 830-372-9042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | J8152
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------