| Southern Ohio Gastroenterology Inc | |
|
8101 Hayport Rd Wheelersburg OH 45694-1769 | |
| (740) 355-8562 | |
| (740) 355-7149 |
| Full Name | Southern Ohio Gastroenterology Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 8101 Hayport Rd, Wheelersburg, Ohio |
| Authorized Official Name and Position | Reshma Banerjee-kataria (OWNER) |
| Authorized Official Contact | 7403558562 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Ohio Gastroenterology Inc Po Box 428 Wheelersburg OH 45694-0428 Ph: (740) 355-8562 | Southern Ohio Gastroenterology Inc 8101 Hayport Rd Wheelersburg OH 45694-1769 Ph: (740) 355-8562 |
| NPI Number | 1669481016 |
|---|---|
| Provider Enumeration Date | 08/05/2006 |
| Last Update Date | 07/28/2015 |
| Medicare PECOS PAC ID | 0042224016 |
|---|---|
| Medicare Enrollment ID | O20060130000011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669481016 | NPI | - | NPPES |
| 2548881 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 34008464 (Ohio) | Primary |
| Provider Name | Reshma Banerjee-kataria |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1053416305 PECOS PAC ID: 2961440672 Enrollment ID: I20050422000531 |
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