| Advanced Gastroenterology & Colon Cancer Screening Center Llc | |
|
763 S New Ballas Rd # 265 Saint Louis MO 63141-8704 | |
| (618) 207-0900 | |
| Not Available |
| Full Name | Advanced Gastroenterology & Colon Cancer Screening Center Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 763 S New Ballas Rd # 265, Saint Louis, Missouri |
| Authorized Official Name and Position | Tarik Firozi (PRESIDENT) |
| Authorized Official Contact | 6182070900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Gastroenterology & Colon Cancer Screening Center Llc 14803 Straub Hill Ln Chesterfield MO 63017-7965 Ph: (618) 207-0900 | Advanced Gastroenterology & Colon Cancer Screening Center Llc 763 S New Ballas Rd # 265 Saint Louis MO 63141-8704 Ph: (618) 207-0900 |
| NPI Number | 1215359484 |
|---|---|
| Provider Enumeration Date | 01/07/2014 |
| Last Update Date | 01/07/2014 |
| Medicare PECOS PAC ID | 4385877315 |
|---|---|
| Medicare Enrollment ID | O20140604001329 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215359484 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 2008030945 (Missouri) | Primary |
| Provider Name | Mohammad Tarik A Firozi |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1962481648 PECOS PAC ID: 6800782517 Enrollment ID: I20140429000164 |
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