MEDICARE: GASTROENTEROLOGY ASSOCIATES 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	:	1710121843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROENTEROLOGY ASSOCIATES PA

Provider Business Mailing Address
First Line	:	PO BOX 8676
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29604-8676
Country	:	US
Telephone Number	:	864-232-7338
Fax Number	:	864-239-6645

Provider Business Practice Location Address
First Line	:	552 MEMORIAL DRIVE EXT STE D
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29651-1135
Country	:	US
Telephone Number	:	864-232-7338
Fax Number	:	864-239-6645

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS SERVICES
Name	:	MRS. NIKKI M HUDSON
Credential	:
Telephone Number	:	864-451-5146

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	04/20/2009

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