| Advanced Gastroenterology, Llc | |
|
520 S 7th St Ste Sb406 Vincennes IN 47591-1038 | |
| (812) 885-8770 | |
| (812) 885-8771 |
| Full Name | Advanced Gastroenterology, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 520 S 7th St Ste Sb406, Vincennes, Indiana |
| Authorized Official Name and Position | Reginald Sandy (PHYSICIAN) |
| Authorized Official Contact | 8128858770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Gastroenterology, Llc Po Box 3276 Evansville IN 47731-3276 Ph: (812) 473-0181 | Advanced Gastroenterology, Llc 520 S 7th St Ste Sb406 Vincennes IN 47591-1038 Ph: (812) 885-8770 |
| NPI Number | 1083851042 |
|---|---|
| Provider Enumeration Date | 01/13/2009 |
| Last Update Date | 11/05/2020 |
| Medicare PECOS PAC ID | 9133482862 |
|---|---|
| Medicare Enrollment ID | O20180411001706 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083851042 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| Provider Name | Reginald Sandy |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1972504629 PECOS PAC ID: 6103974167 Enrollment ID: I20090430000265 |
| Provider Name | Stacy A Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982000568 PECOS PAC ID: 1850614900 Enrollment ID: I20141223000282 |
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