Main Line Gastroenterology Associates, PC

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

Legal business name

MAIN LINE GASTROENTEROLOGY ASSOCIATES, PC

Practice address

255 W Lancaster Ave
Paoli Medical Building, Suite 332
Paoli, PA 19301-1763

Phone

(610) 644-6755

Fax

(610) 647-2063

NPI assigned

Dec 22, 2008

Last updated

Dec 22, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ellie Suder

Title

Billing Manager

Phone

(215) 723-2333

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229904000000",
    "number": "1053557082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W LANCASTER AVE",
            "address_2": "PAOLI MEDICAL BUILDING, SUITE 332",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011763",
            "telephone_number": "610-644-6755",
            "fax_number": "610-647-2063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 W LANCASTER AVE",
            "address_2": "PAOLI MEDICAL BUILDING, SUITE 332",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011763",
            "telephone_number": "610-644-6755",
            "fax_number": "610-647-2063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN LINE GASTROENTEROLOGY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-22",
        "last_updated": "2008-12-22",
        "status": "A",
        "authorized_official_last_name": "SUDER",
        "authorized_official_first_name": "ELLIE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "215-723-2333"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Certified Registered Nurse Anesthetist in Paoli, PA
• Providers in Paoli, PA by specialty
• Certified Registered Nurse Anesthetist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.