Organization
GASTROINTESTINAL INSTITUTE, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHIL ARTHUR MCGOWAN (ADMINISTRATOR)
(309) 451-1123
Entity
Organization
Contact information
Practice address
2200 JACOBSSEN DR STE A, NORMAL, IL 61761-5516
(309) 451-1121
(309) 451-1212
Mailing address
2200 JACOBSSEN DR, SUITE A, NORMAL, IL 61761-5516
(309) 451-1121
(309) 451-1212
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7003056
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50492
BLUECROSSBLUESHIELD OF ILLINOIS
IL
Enumeration date
01/05/2007
Last updated
12/08/2023
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