MEDICARE: CENTER FOR DIGESTIVE DISEASES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	ME48637	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CL1357	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24038	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619900248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR DIGESTIVE DISEASES PA

Provider Business Mailing Address
First Line	:	PO BOX 20267
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33622-0267
Country	:	US
Telephone Number	:	727-823-2188
Fax Number	:	727-828-0723

Provider Business Practice Location Address
First Line	:	1609 PASADENA AVE S
Second Line	:	STE 3M
City	:	ST PETERSBURG
State	:	FL
Zip	:	33707-4563
Country	:	US
Telephone Number	:	727-384-2016
Fax Number	:	727-343-3791

Authorized Official
Title or Position	:	SCHEDULE COORNIDATOR
Name	:	MS. KATHY F JACKSON
Credential	:
Telephone Number	:	727-384-2016

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	06/18/2009

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Directions to “CENTER FOR DIGESTIVE DISEASES PA ” Practice Location

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