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Organization

GASTROINTESTINAL ASSOCIATES ENDOSCOPY CENTER, LLC

Active
Parent organization
GASTROINTESTINAL ASSOCIATES ENDOSCOPY CENTER, LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
GASTROINTESTINAL ASSOCIATES ENDOSCOPY CENTER, LLC
Authorized official
PIERCE D. DOTHEROW M.D. (AUTHORIZED OFFICIAL)
(601) 355-1234
Entity
Organization

Contact information

Practice address
1815 MISSION 66, VICKSBURG, MS 39180-3709
(601) 355-1234
(601) 326-3566
Mailing address
2510 LAKELAND DR, FLOWOOD, MS 39232-9513
(601) 355-1234
(601) 326-3566

Taxonomy

Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
25C0001065
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
04837303
MS
Enumeration date
08/10/2007
Last updated
12/06/2016
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