| Tri-state Gastroenterology P.c. | |
|
4133 Gateway Blvd Suite 290 Newburgh IN 47630-7953 | |
| (812) 842-2701 | |
| (812) 842-2717 |
| Full Name | Tri-state Gastroenterology P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 4133 Gateway Blvd, Newburgh, Indiana |
| Authorized Official Name and Position | Gregory S Mccord (PHYSICIAN) |
| Authorized Official Contact | 8128422701 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tri-state Gastroenterology P.c. Po Box 5068 Evansville IN 47716-5068 Ph: (812) 842-2701 | Tri-state Gastroenterology P.c. 4133 Gateway Blvd Suite 290 Newburgh IN 47630-7953 Ph: (812) 842-2701 |
| NPI Number | 1811935067 |
|---|---|
| Provider Enumeration Date | 06/02/2006 |
| Last Update Date | 04/15/2014 |
| Medicare PECOS PAC ID | 4880781608 |
|---|---|
| Medicare Enrollment ID | O20071025000665 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811935067 | NPI | - | NPPES |
| 200073540A | Medicaid | IN | |
| 100180010A | Medicaid | IN | |
| 100002411 | Other | RAILROAD MEDICARE | |
| 000000042589 | Other | ANTHEM | |
| 400746743 | Medicaid | IL | |
| 64871676 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 01038295 (Indiana) | Primary |
| Provider Name | Gregory Mccord |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1720116924 PECOS PAC ID: 6507953320 Enrollment ID: I20101015000772 |
| Provider Name | Tarah Bracher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487266326 PECOS PAC ID: 2062827066 Enrollment ID: I20210225002158 |
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