=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437336211
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PANHANDLE GASTROENTEROLOGY, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2008
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 QUAIL CREEK DR SUITE 101
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79124-1634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-354-9400
-----------------------------------------------------
Fax | 806-354-9403
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 50537
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79159-0537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-354-9400
-----------------------------------------------------
Fax | 806-354-9403
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. KULDIP S BANWAIT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 806-354-9400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | M4993
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------