MEDICARE: GASTROENTEROLOGY CARE CONSULTANTS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1285807420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROENTEROLOGY CARE CONSULTANTS PA

Provider Business Mailing Address
First Line	:	PO BOX 2183
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-7183
Country	:	US
Telephone Number	:	817-599-6222
Fax Number	:	817-599-8151

Provider Business Practice Location Address
First Line	:	750 EUREKA ST
Second Line	:	SUITE B
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-6521
Country	:	US
Telephone Number	:	817-599-6222
Fax Number	:	817-599-8151

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. SANJEEB SHRESTHA
Credential	:	MD
Telephone Number	:	817-599-6222

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	12/28/2011

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