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1063802734 NPI number — TRI-STATE GASTROENTEROLOGY ASSOCIATES, PLLC

NPI Number: 1063802734
Health Care Provider/Practitioner: TRI-STATE GASTROENTEROLOGY ASSOCIATES, PLLC

Information about “1063802734” NPI (TRI-STATE GASTROENTEROLOGY ASSOCIATES, PLLC) exists in 1063802734 in HTML format HTML  |  1063802734 in plain Text format TXT  |  1063802734 in PDF (Portable Document Format) PDF  |  1063802734 in an XML format XML  formats.

NPI Number : 1063802734 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063802734",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "TRI-STATE GASTROENTEROLOGY ASSOCIATES, PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2106 OOLTEWAH RINGGOLD RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OOLTEWAH",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37363-9345",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "931-284-9660",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "935 SPRING CREEK RD",
    "SecondLinePracticeLocationAddress": "SUITE 203",
    "PracticeLocationAddressCityName": "CHATTANOOGA",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37412-3993",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "423-760-4360",
    "PracticeLocationAddressFaxNumber": "423-760-4361",
    "EnumerationDate": "02/02/2015",
    "LastUpdateDate": "06/03/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SHAH",
    "AuthorizedOfficialFirstName": "NIKHIL",
    "AuthorizedOfficialMiddleName": "S",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "931-284-9660",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207RG0100X",
          "TaxonomyName": "Gastroenterology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM2500X",
          "TaxonomyName": "Medical Specialty Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RG0100X",
          "TaxonomyName": "Gastroenterology Physician",
          "LicenseNumber": "36425",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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