Advanced Gastroenterology & Colon Cancer Screening Center LLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

2008030945 Issued in MO

Legal business name

ADVANCED GASTROENTEROLOGY & COLON CANCER SCREENING CENTER LLC

Practice address

763 S New Ballas Rd # 265
Saint Louis, MO 63141-8704

Phone

(618) 207-0900

NPI assigned

Jan 7, 2014

Organization subpart

No

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

Authorized official

Name

Tarik Firozi, MD

Title

President

Phone

(618) 207-0900

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mohammad Tarik Alam Firozi, MD

  • Gastroenterology Physician
  • Saint Louis, MO
  • NPI 1962481648
  Medicare reassignment NPD

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

{
    "created_epoch": "1389052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389052800000",
    "number": "1215359484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14803 STRAUB HILL LN",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630177965",
            "telephone_number": "618-207-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "763 S NEW BALLAS RD # 265",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418704",
            "telephone_number": "618-207-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED GASTROENTEROLOGY & COLON CANCER SCREENING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-07",
        "last_updated": "2014-01-07",
        "status": "A",
        "authorized_official_last_name": "FIROZI",
        "authorized_official_first_name": "TARIK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-207-0900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "2008030945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.