=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205885324
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLUMBIA GASTROENTEROLOGY & LIVER ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1605 E BROADWAY SUITE 250
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65201-8023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-449-8680
-----------------------------------------------------
Fax | 573-449-8684
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1605 E BROADWAY STE 250
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65201-8023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-449-8680
-----------------------------------------------------
Fax | 573-449-8684
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. PAUL D. KING
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 573-449-8680
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------