Premier Gastroenterology, P. C.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

PREMIER GASTROENTEROLOGY, P. C.

Practice address

7900 Airways Blvd
BLDG a Ste 3a
Southaven, MS 38671-4113

Phone

(662) 349-6113

Fax

(662) 349-6188

NPI assigned

Aug 5, 2006

Organization subpart

No

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

Authorized official

Name

Tariq A. Khan, M.D.

Title

President

Phone

(662) 349-6113

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1104835461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40895",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381740895",
            "telephone_number": "662-349-6113",
            "fax_number": "662-349-6188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 AIRWAYS BLVD",
            "address_2": "BLDG A STE 3A",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386714113",
            "telephone_number": "662-349-6113",
            "fax_number": "662-349-6188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER GASTROENTEROLOGY, P. C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "TARIQ",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-349-6113",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015473",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "3150548",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "631263936E",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Southaven, MS
• Providers in Southaven, MS by specialty
• Specialist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.