MEDICARE: GI ASSOCIATES, 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	207RG0100X	Gastroenterology Physician	MD12260	OR

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	:	1962637058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GI ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	2560 NW MEDICAL PARK DR
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-5510
Country	:	US
Telephone Number	:	541-673-2044
Fax Number	:	541-673-0454

Provider Business Practice Location Address
First Line	:	2560 NW MEDICAL PARK DR
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97471-5510
Country	:	US
Telephone Number	:	541-673-2044
Fax Number	:	541-673-0454

Authorized Official
Title or Position	:	CORP PRESIDENT
Name	:	THOMAS J HARPOLE
Credential	:	MD
Telephone Number	:	541-673-2044

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	05/19/2009

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