Provider Demographics
NPI:1063802734
Name:TRI-STATE GASTROENTEROLOGY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:TRI-STATE GASTROENTEROLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKHIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-284-9660
Mailing Address - Street 1:2106 OOLTEWAH RINGGOLD RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9345
Mailing Address - Country:US
Mailing Address - Phone:931-284-9660
Mailing Address - Fax:
Practice Address - Street 1:935 SPRING CREEK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-3993
Practice Address - Country:US
Practice Address - Phone:423-760-4360
Practice Address - Fax:423-760-4361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RG0100X, 261QM2500X
TN36425207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty