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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