Organization
GASTROENTEROLOGY CONSULTANTS MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA MARIE JOHNSTON (PRACTICE ADMINISTRATOR)
(916) 423-2123
Entity
Organization
Contact information
Practice address
8120 TIMBERLAKE WAY, STE 101, SACRAMENTO, CA 95823-5412
(916) 423-2124
(916) 423-2127
Mailing address
8120 TIMBERLAKE WAY, STE 101, SACRAMENTO, CA 95823-5412
(916) 423-2124
(916) 423-2127
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
FNP 5539
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP6115
RAILROAD MEDICARE
CA
05
—
ZZZ80876Z
—
CA
Enumeration date
02/16/2006
Last updated
11/19/2018
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