Provider Demographics
NPI:1487799722
Name:SOUTHWEST CENTER FOR GASTROENTEROLOGY
Entity type:Organization
Organization Name:SOUTHWEST CENTER FOR GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-425-9456
Mailing Address - Street 1:9921 SOUTHWEST HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-425-9456
Mailing Address - Fax:708-425-9468
Practice Address - Street 1:9921 SOUTHWEST HIGHWAY
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-425-9456
Practice Address - Fax:708-425-9468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212208Medicare ID - Type Unspecified
IL526690Medicare ID - Type Unspecified