Provider Demographics
NPI:1538267067
Name:TEXAS INSTITUTE OF GASTROENTEROLOGY ASSOCIATES , PA
Entity type:Organization
Organization Name:TEXAS INSTITUTE OF GASTROENTEROLOGY ASSOCIATES , PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCELYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:THEARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-268-0120
Mailing Address - Street 1:19284 STONE OAK PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3474
Mailing Address - Country:US
Mailing Address - Phone:210-268-0120
Mailing Address - Fax:210-268-0170
Practice Address - Street 1:19284 STONE OAK PKWY STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3474
Practice Address - Country:US
Practice Address - Phone:210-268-0120
Practice Address - Fax:210-268-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180512902Medicaid
TX0028NPOtherBCBS
TX00W477Medicare ID - Type Unspecified