Provider Demographics
NPI:1144454703
Name:WEST CENTRAL GASTROENTEROLOGY LLP
Entity type:Organization
Organization Name:WEST CENTRAL GASTROENTEROLOGY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-329-3371
Mailing Address - Street 1:3001 EXECUTIVE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5323
Mailing Address - Country:US
Mailing Address - Phone:727-347-0005
Mailing Address - Fax:727-541-6558
Practice Address - Street 1:3001 EXECUTIVE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-5323
Practice Address - Country:US
Practice Address - Phone:727-347-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7225133V00000X
FLME68156207RI0008X
FLOS4755207ZC0500X
FL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0003JOtherBCBS
FL001174000Medicaid