NPI Code Detail JSON Logo

1215359484 NPI number — ADVANCED GASTROENTEROLOGY & COLON CANCER SCREENING CENTER LLC

NPI Number: 1215359484
Health Care Provider/Practitioner: ADVANCED GASTROENTEROLOGY & COLON CANCER SCREENING CENTER LLC

Information about “1215359484” NPI (ADVANCED GASTROENTEROLOGY & COLON CANCER SCREENING CENTER LLC) exists in 1215359484 in HTML format HTML  |  1215359484 in plain Text format TXT  |  1215359484 in PDF (Portable Document Format) PDF  |  1215359484 in an XML format XML  formats.

NPI Number : 1215359484 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215359484",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ADVANCED GASTROENTEROLOGY & COLON CANCER SCREENING CENTER LLC",
    "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": "14803 STRAUB HILL LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHESTERFIELD",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63017-7965",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "618-207-0900",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "763 S NEW BALLAS RD # 265",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63141-8704",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "618-207-0900",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/07/2014",
    "LastUpdateDate": "01/07/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FIROZI",
    "AuthorizedOfficialFirstName": "TARIK",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "618-207-0900",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207RG0100X",
        "TaxonomyName": "Gastroenterology Physician",
        "LicenseNumber": "2008030945",
        "LicenseNumberStateCode": "MO",
        "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."
      }
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.