| Kentuckiana Gastroenterology Psc | |
|
1003 N Dupont Sq # 9a Louisville KY 40207-4612 | |
| (502) 893-7744 | |
| (502) 893-7741 |
| Full Name | Kentuckiana Gastroenterology Psc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1003 N Dupont Sq # 9a, Louisville, Kentucky |
| Authorized Official Name and Position | Anand Gupta (OWNER) |
| Authorized Official Contact | 5028937744 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kentuckiana Gastroenterology Psc 1003 N Dupont Sq # 9a Louisville KY 40207-4612 Ph: (502) 893-7744 | Kentuckiana Gastroenterology Psc 1003 N Dupont Sq # 9a Louisville KY 40207-4612 Ph: (502) 893-7744 |
| NPI Number | 1336310135 |
|---|---|
| Provider Enumeration Date | 03/19/2008 |
| Last Update Date | 03/06/2020 |
| Medicare PECOS PAC ID | 3173609872 |
|---|---|
| Medicare Enrollment ID | O20080320000416 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336310135 | NPI | - | NPPES |
| 24420293000 | Other | KY | PASSPORT ADVANTAGE |
| 50015404 | Other | KY | PASSPORT HEALTH |
| 64343585 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 33458 (Kentucky) | Primary |
| Provider Name | Anand M Gupta |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1841299138 PECOS PAC ID: 8022065101 Enrollment ID: I20050527000221 |
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