| Gastroenterology Practice | |
|
1310 N 24th St Ste 100 Phoenix AZ 85008 | |
| (602) 254-6101 | |
| (602) 279-1720 |
| Full Name | Gastroenterology Practice |
|---|---|
| Speciality | Internal Medicine |
| Location | 1310 N 24th St Ste 100, Phoenix, Arizona |
| Authorized Official Name and Position | Rushda Mumtaz (PRESIDENT) |
| Authorized Official Contact | 6023097716 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gastroenterology Practice 2902 E Gary Way Phoenix AZ 85042-7107 Ph: (602) 309-7716 | Gastroenterology Practice 1310 N 24th St Ste 100 Phoenix AZ 85008 Ph: (602) 254-6101 |
| NPI Number | 1528305281 |
|---|---|
| Provider Enumeration Date | 01/14/2013 |
| Last Update Date | 08/21/2018 |
| Medicare PECOS PAC ID | 5294972410 |
|---|---|
| Medicare Enrollment ID | O20130507000719 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528305281 | NPI | - | NPPES |
| 550899 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 28980 (Arizona) | Primary |
| Provider Name | Rushda Mumtaz |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1134101892 PECOS PAC ID: 1951358266 Enrollment ID: I20050407000847 |
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