Provider Demographics
NPI:1992723571
Name:GASTROENTEROLOGY CENTER OF THE SOUTH, APMC
Entity type:Organization
Organization Name:GASTROENTEROLOGY CENTER OF THE SOUTH, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:PELLEGRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-851-5206
Mailing Address - Street 1:8120 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3403
Mailing Address - Country:US
Mailing Address - Phone:985-851-5206
Mailing Address - Fax:985-851-5224
Practice Address - Street 1:8120 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3403
Practice Address - Country:US
Practice Address - Phone:985-851-5206
Practice Address - Fax:985-851-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18280207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1941352Medicaid
LA57163Medicare ID - Type Unspecified