=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801994157
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTERS FOR GASTROENTEROLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 09/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3702 S TIMBERLINE RD
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-3624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-207-9773
-----------------------------------------------------
Fax | 970-207-1893
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3702 S TIMBERLINE RD
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-3624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-207-9773
-----------------------------------------------------
Fax | 970-207-1893
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING COORDINATOR
-----------------------------------------------------
Name | BILLIE BEDDOE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-212-0879
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------