Provider Demographics
NPI:1750922399
Name:GASTROENTEROLOGY CARE SPECIALISTS, LLC
Entity type:Organization
Organization Name:GASTROENTEROLOGY CARE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-405-5441
Mailing Address - Street 1:550 REDSTONE AVE W STE 430
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-6457
Mailing Address - Country:US
Mailing Address - Phone:850-398-8605
Mailing Address - Fax:
Practice Address - Street 1:150 E REDSTONE AVE STE B
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5343
Practice Address - Country:US
Practice Address - Phone:850-398-8605
Practice Address - Fax:850-398-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty