Organization
GASTROENTEROLOGY GROUP, LLC
Active
Other names
Gastroenterology Group, AMC, Gastroenterology Group, A Medical Corporation
Organization subpart
No
Provider details
NPI number
Authorized official
HAZEL BRAUEN (PRACTICE MANAGER)
(985) 871-1721
Entity
Organization
Contact information
Practice address
131 CHEROKEE ROSE LN, COVINGTON, LA 70433-7195
(985) 871-1721
(985) 871-4049
Mailing address
PO BOX 848778, BOSTON, MA 02284-8778
(985) 871-1721
(985) 893-6908
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015774
—
MS
05
—
1799181
—
LA
01
—
CG2313
MEDICARE RAILROAD
LA
01
—
CK5954
MEDICARE RAILROAD
MS
01
—
CN9069
MEDICARE RAILROAD
LA
Enumeration date
06/12/2006
Last updated
06/09/2022
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