Provider Demographics
NPI:1215979919
Name:THE GASTROENTEROLOGY CLINIC, PLC
Entity type:Organization
Organization Name:THE GASTROENTEROLOGY CLINIC, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:319-758-9075
Mailing Address - Street 1:1223 S GEAR AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1682
Mailing Address - Country:US
Mailing Address - Phone:319-758-9075
Mailing Address - Fax:319-758-9079
Practice Address - Street 1:1223 S GEAR AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1682
Practice Address - Country:US
Practice Address - Phone:319-758-9075
Practice Address - Fax:319-758-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03066207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1151191Medicaid
IA58751OtherBLUE CROSS
IADE9199OtherRR MEDICARE
E69181Medicare UPIN
IAI17714Medicare PIN