Southwest Gastroenterology, LLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

2006024391 Issued in MO

Legal business name

SOUTHWEST GASTROENTEROLOGY, LLC

Practice address

2817 MC Clelland Blvd
Suite 153
Joplin, MO 64804-1629

Phone

(417) 206-4928

Fax

(417) 206-4734

NPI assigned

Aug 17, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Xujun Wu, M.D.

Title

President

Phone

(330) 409-3337

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679686182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 MC CLELLAND BLVD",
            "address_2": "SUITE 153",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041629",
            "telephone_number": "417-206-4928",
            "fax_number": "417-206-4734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 MC CLELLAND BLVD",
            "address_2": "SUITE 153",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041629",
            "telephone_number": "417-206-4928",
            "fax_number": "417-206-4734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST GASTROENTEROLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WU",
        "authorized_official_first_name": "XUJUN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-409-3337",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "2006024391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF MO LICENSE",
            "identifier": "2006024391",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2514363",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Joplin, MO
• Providers in Joplin, MO by specialty
• Gastroenterology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.