Provider Demographics
NPI:1104152016
Name:GASTROENTEROLOGY ASSOCIATES PLLC
Entity type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTRILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-307-3144
Mailing Address - Street 1:PO BOX 700930
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-0930
Mailing Address - Country:US
Mailing Address - Phone:918-307-3144
Mailing Address - Fax:918-307-3145
Practice Address - Street 1:10505 E 91ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5803
Practice Address - Country:US
Practice Address - Phone:918-307-3144
Practice Address - Fax:918-307-3145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5816Medicare PIN