Provider Demographics
NPI:1528136009
Name:FOOTHILLS GASTROENTEROLOGY MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:FOOTHILLS GASTROENTEROLOGY MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERENCZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-914-1182
Mailing Address - Street 1:210 S GRAND AVE
Mailing Address - Street 2:SUITE 415
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4292
Mailing Address - Country:US
Mailing Address - Phone:626-914-1182
Mailing Address - Fax:626-914-9713
Practice Address - Street 1:210 S GRAND AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4292
Practice Address - Country:US
Practice Address - Phone:626-914-1182
Practice Address - Fax:626-914-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0066870Medicaid
CAGR0066870Medicaid