| Gastroenterology Of The Four States,llc | |
|
2024 S Maiden Ln Ste 204 Joplin MO 64804-0319 | |
| (417) 222-3434 | |
| (417) 222-3435 |
| Full Name | Gastroenterology Of The Four States,llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2024 S Maiden Ln Ste 204, Joplin, Missouri |
| Authorized Official Name and Position | Nadia L Sinnett (OFFICE MANAGER) |
| Authorized Official Contact | 4172223434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gastroenterology Of The Four States,llc Po Box 4439 Joplin MO 64803-4439 Ph: (417) 214-0034 | Gastroenterology Of The Four States,llc 2024 S Maiden Ln Ste 204 Joplin MO 64804-0319 Ph: (417) 222-3434 |
| NPI Number | 1316589708 |
|---|---|
| Provider Enumeration Date | 10/17/2019 |
| Last Update Date | 11/12/2019 |
| Medicare PECOS PAC ID | 9032544143 |
|---|---|
| Medicare Enrollment ID | O20200120000095 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316589708 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Geoffrey Glen Graham |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1003041625 PECOS PAC ID: 5496926503 Enrollment ID: I20161229000972 |
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