Provider Demographics
NPI:1306049580
Name:GASTROENTEROLOGY CONSULTANTS OF TUSCALOOSA
Entity type:Organization
Organization Name:GASTROENTEROLOGY CONSULTANTS OF TUSCALOOSA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADISESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-345-0010
Mailing Address - Street 1:100 RICE MINE RD N STE E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2375
Mailing Address - Country:US
Mailing Address - Phone:205-345-0010
Mailing Address - Fax:205-752-1175
Practice Address - Street 1:100 RICE MINE RD N STE E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2375
Practice Address - Country:US
Practice Address - Phone:205-345-0010
Practice Address - Fax:205-752-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALU6302261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical