| Gastrointestinal Associates, P.A. | |
|
1815 Mission 66 Vicksburg MS 39180-3709 | |
| (601) 355-1234 | |
| (601) 326-3566 |
| Full Name | Gastrointestinal Associates, P.A. |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 1815 Mission 66, Vicksburg, Mississippi |
| Authorized Official Name and Position | Pierce D Dotherow (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 6013551234 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gastrointestinal Associates, P.A. 2510 Lakeland Dr Flowood MS 39232-9513 Ph: (601) 355-1234 | Gastrointestinal Associates, P.A. 1815 Mission 66 Vicksburg MS 39180-3709 Ph: (601) 355-1234 |
| NPI Number | 1144412438 |
|---|---|
| Provider Enumeration Date | 08/10/2007 |
| Last Update Date | 12/06/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144412438 | NPI | - | NPPES |
| 09852713 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (NU) | Primary |
| 2080P0206X | Pediatrics - Pediatric Gastroenterology | (NU) | Secondary |
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