Organization
PREMIER GASTROENTEROLOGY, P. C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARIQ A. KHAN M.D. (PRESIDENT)
(662) 349-6113
Entity
Organization
Contact information
Practice address
7900 AIRWAYS BLVD, BLDG A STE 3A, SOUTHAVEN, MS 38671-4113
(662) 349-6113
(662) 349-6188
Mailing address
PO BOX 40895, MEMPHIS, TN 38174-0895
(662) 349-6113
(662) 349-6188
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015473
—
MS
01
—
3150548
BLUE CROSS
TN
01
—
631263936E
BLUE CROSS
MS
Enumeration date
08/05/2006
Last updated
05/07/2008
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