Basic Information
| Provider Information | |||||||||
| NPI: | 1154442630 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROENTEROLOGY ASSOCIATES PA | ||||||||
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| OtherOrganizationName: | GASTROENTEROLOGY ASSOCIATES ENDOSCOPY UNIT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 N CENTER ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286015036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283283300 | ||||||||
| FaxNumber: | 8283289101 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 N CENTER ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286015036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283283300 | ||||||||
| FaxNumber: | 8283289101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 04/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | RIDLEY | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8283283300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 34C0001119 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 34C0001119 | 01 | NC | NC STATE LICENSE NUMBER | OTHER |