Riverside Gastroenterology Pc | |
1304 Somerville Rd Se Decatur AL 35601-4354 | |
(256) 260-2333 | |
(256) 260-2336 |
Full Name | Riverside Gastroenterology Pc |
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Speciality | Internal Medicine |
Location | 1304 Somerville Rd Se, Decatur, Alabama |
Authorized Official Name and Position | Thomas Short (PRESIDENT) |
Authorized Official Contact | 2562602333 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Riverside Gastroenterology Pc 1304 Somerville Rd Se Decatur AL 35601-4354 Ph: (256) 260-2333 | Riverside Gastroenterology Pc 1304 Somerville Rd Se Decatur AL 35601-4354 Ph: (256) 260-2333 |
NPI Number | 1669762480 |
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Provider Enumeration Date | 04/13/2011 |
Last Update Date | 04/13/2011 |
Medicare PECOS PAC ID | 3476730409 |
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Medicare Enrollment ID | O20110531000514 |
Identifier | Type | State | Issuer |
---|---|---|---|
1669762480 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
Provider Name | Thomas Short |
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Provider Type | Practitioner - Gastroenterology |
Provider Identifiers | NPI Number: 1144219148 PECOS PAC ID: 9830186311 Enrollment ID: I20050906000712 |
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