Provider Demographics
NPI:1770718405
Name:MID-SOUTH GASTROENTEROLOGY ASSOC PC
Entity type:Organization
Organization Name:MID-SOUTH GASTROENTEROLOGY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN CORP
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHOKSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-388-8302
Mailing Address - Street 1:PO BOX 131149
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-6149
Mailing Address - Country:US
Mailing Address - Phone:877-319-7141
Mailing Address - Fax:877-243-2920
Practice Address - Street 1:1510 1/2 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4825
Practice Address - Country:US
Practice Address - Phone:931-381-7818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-SOUTH GASTROENTEROLOGY ASSOC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-26
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702673Medicare PIN