MEDICARE: CONROE-WOODLANDS GASTROENTEROLOGY, P.A.

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

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	:	1962539155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONROE-WOODLANDS GASTROENTEROLOGY, P.A.

Provider Business Mailing Address
First Line	:	1020 RIVERWOOD CT STE 300
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2974
Country	:	US
Telephone Number	:	936-760-1900
Fax Number	:	936-441-1907

Provider Business Practice Location Address
First Line	:	1020 RIVERWOOD CT STE 300
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2974
Country	:	US
Telephone Number	:	936-760-1900
Fax Number	:	936-441-1907

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN MICHAEL KELLY
Credential	:	MD
Telephone Number	:	936-760-1900

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/29/2023

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