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SOUDER GASTRO
NPI 1174356489
Clinic/Center - Endoscopy in Medina, TN

Active since August 22, 2024
150 FRIENDSHIP RD, MEDINA, TN 38355(731) 697-2229 Get Directions Write a Review

NPPES record last updated: August 22, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Table of Contents

  1. NPI Profile Information
  2. Primary Taxonomy
  3. Authorized Official
  4. Frequently Asked Questions
  • Organization
  • Clinic/Center
  • Endoscopy

About SOUDER GASTRO

This page provides the complete NPI Profile along with additional information for Souder Gastro, a provider established in Medina, Tennessee operating as a Clinic/center, focusing in endoscopy . The healthcare provider is registered in the NPI registry with number 1174356489 assigned on August 2024. The practitioner's primary taxonomy code is 261QE0800X. The provider is registered as an organization and their NPI record was last updated 2 years ago. The authorized official of this NPI record is Bob Souder Md (President)

NPI
1174356489 Verify this NPI
Provider Name
SOUDER GASTRO
Entity Type
Organization
Location Address
150 FRIENDSHIP RD MEDINA, TN 38355
Location Phone
(731) 697-2229
Mailing Address
150 FRIENDSHIP RD MEDINA, TN 38355
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
08-22-2024
Last Update Date
08-22-2024
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Clinic/Center Endoscopy

Taxonomy Code
261QE0800X
Type
Ambulatory Health Care Facilities

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

BOB SOUDER MD

Authorized Official Title
PRESIDENT
Authorized Official Phone
(731) 697-2229

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Frequently Asked Questions

What is SOUDER GASTRO's NPI number?

The NPI number assigned to this healthcare provider is 1174356489, enumerated as an "organization" on August 22, 2024.

Where is the provider located?

The provider is located at 150 FRIENDSHIP RD MEDINA, TN 38355 and the phone number is (731) 697-2229.

What is the provider's specialty?

Clinic/Center with taxonomy code 261QE0800X and a focus in Endoscopy.