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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851395792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROENTEROLOGY ASSOCIATES PA

Provider Business Mailing Address
First Line	:	409 N UNIVERSITY AVE
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-3108
Country	:	US
Telephone Number	:	501-664-6980
Fax Number	:	501-664-4738

Provider Business Practice Location Address
First Line	:	11700 CANTRELL RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72223-1705
Country	:	US
Telephone Number	:	501-664-6980
Fax Number	:	501-664-4738

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ALISA PETET-MCELFRESH
Credential	:
Telephone Number	:	501-664-6980

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	12/12/2024

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