| Gastroenterology And Liver Disease Medical Center Inc | |
|
7215 N Fresno St #101 Fresno CA 93720-2969 | |
| (559) 449-0309 | |
| (559) 449-0609 |
| Full Name | Gastroenterology And Liver Disease Medical Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7215 N Fresno St, Fresno, California |
| Authorized Official Name and Position | Audra E Orbaker (ADMINISTRATOR) |
| Authorized Official Contact | 5597609981 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gastroenterology And Liver Disease Medical Center Inc 7215 N Fresno St #101 Fresno CA 93720-2969 Ph: (559) 449-0309 | Gastroenterology And Liver Disease Medical Center Inc 7215 N Fresno St #101 Fresno CA 93720-2969 Ph: (559) 449-0309 |
| NPI Number | 1780631127 |
|---|---|
| Provider Enumeration Date | 05/30/2006 |
| Last Update Date | 03/21/2024 |
| Medicare PECOS PAC ID | 2163684044 |
|---|---|
| Medicare Enrollment ID | O20120510000638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780631127 | NPI | - | NPPES |
| ZZZH1024Z | Other | CA | BLUE SHIELD |
| SUR01593F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | AS1593001 (California) | Primary |
| Provider Name | Ram Mittal |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1306893516 PECOS PAC ID: 8022085950 Enrollment ID: I20040910001179 |
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