MEDICARE: INTEGRATED GASTROENTEROLOGY CONSULTANTS PC

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1558150052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED GASTROENTEROLOGY CONSULTANTS PC

Provider Business Mailing Address
First Line	:	41 WELLMAN ST # 400
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01851-5161
Country	:	US
Telephone Number	:	978-459-6737
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 FEDERAL ST # 103B
Second Line	:
City	:	ANDOVER
State	:	MA
Zip	:	01810-1038
Country	:	US
Telephone Number	:	978-459-6737
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	RICHARD S. TILSON
Credential	:	MD
Telephone Number	:	978-459-6737

Provider Enumeration Date	:	05/02/2025
Last Update Date	:	06/18/2025

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