Active NPI
Mga Gastrointestinal Diagnostic & Therapeutic Center
- Endoscopy Clinic/Center
- Marrero, LA
National Provider Identifier
1306862941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endoscopy Clinic/Center
- License
- 60
- Legal business name
- MGA GASTROINTESTINAL DIAGNOSTIC & THERAPEUTIC CENTER
- Practice address
- 1111 Medical Center Blvd
S450
Marrero, LA 70072-3151 - Phone
- (504) 349-6309
- NPI assigned
- Jul 15, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Christopher A Holden
- Title
- Chief Manager of LLC
- Phone
- (615) 665-1283
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endoscopy Clinic/Center | 261QE0800X | 60 | LA | Primary |
Addresses
Primary practice location
1111 Medical Center Blvd
S450
Marrero, LA 70072-3151
Mailing address
PO Box 1187
Marrero, LA 70073-1187
Phone (504) 349-6423
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1980714 | Medicaid | LA |
Other names 1
- MGA Gastrointestinal Diagnostic and Therapeutic Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070507000561 | LA | Part B Supplier - Ambulatory Surgical Center | 5890891915 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Marrero, LA |
| O20070509000015 | LA | Part B Supplier - Ambulatory Surgical Center | 5890891915 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: New Orleans, LA |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Ambulatory Surgical Clinic/Center
- Marrero, LA
- NPI 1780865634
O20070507000561
-
- Ambulatory Surgical Clinic/Center
- New Orleans, LA
- NPI 1821279720
O20070509000015
National Provider Directory
National Provider Directory- Tax ID family
- Mga Gastrointestinal Diagnostic Therapeutic Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Endoscopy Clinic/Center
- New Orleans, LA
- NPI 1578744470
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152921600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1190937600000",
"number": "1306862941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1187",
"city": "MARRERO",
"state": "LA",
"postal_code": "700731187",
"telephone_number": "504-349-6423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 MEDICAL CENTER BLVD",
"address_2": "S450",
"city": "MARRERO",
"state": "LA",
"postal_code": "700723151",
"telephone_number": "504-349-6309"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MGA GASTROINTESTINAL DIAGNOSTIC & THERAPEUTIC CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-15",
"last_updated": "2007-09-28",
"status": "A",
"authorized_official_last_name": "HOLDEN",
"authorized_official_first_name": "CHRISTOPHER",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "CHIEF MANAGER OF LLC",
"authorized_official_telephone_number": "615-665-1283",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QE0800X",
"taxonomy_group": "",
"desc": "Clinic/Center, Endoscopy",
"state": "LA",
"license": "60",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1980714",
"state": "LA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "MGA Gastrointestinal Diagnostic and Therapeutic Center",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Marrero, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2007; 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.