Organization
CONSULTANTS IN GASTROENTEROLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA R REYNA (CREDENTIALING COORDINATOR)
(816) 478-4887
Entity
Organization
Contact information
Practice address
3800 S WHITNEY AVE, SUITE 200, INDEPENDENCE, MO 64055-6739
(816) 478-4887
(816) 478-7140
Mailing address
17501 E US HIGHWAY 40, SUITE 213A, INDEPENDENCE, MO 64055-5442
(816) 478-4887
(816) 478-7140
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501536809
—
MO
Enumeration date
01/18/2006
Last updated
11/02/2011
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