Provider Demographics
NPI:1679507925
Name:CENTRAL FLORIDA GASTROENTEROLOGY P A
Entity type:Organization
Organization Name:CENTRAL FLORIDA GASTROENTEROLOGY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE/SECRATERY
Authorized Official - Prefix:MRS
Authorized Official - First Name:PURNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-775-4720
Mailing Address - Street 1:1053 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE # 251
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8260
Mailing Address - Country:US
Mailing Address - Phone:386-775-4720
Mailing Address - Fax:386-775-6343
Practice Address - Street 1:1053 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 251
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8260
Practice Address - Country:US
Practice Address - Phone:386-775-4720
Practice Address - Fax:386-775-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060089207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053601600Medicaid
FLE68437Medicare UPIN
FL21504Medicare PIN