Healthcare Provider Details

I. General information

NPI: 1891889945
Provider Name (Legal Business Name): DIGESTIVE CARE MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000A LAUREL STREET
SAN CARLOS CA
94070-3919
US

IV. Provider business mailing address

PO BOX 7625
MENLO PARK CA
94026-7625
US

V. Phone/Fax

Practice location:
  • Phone: 650-596-8800
  • Fax: 650-596-8802
Mailing address:
  • Phone: 650-596-8800
  • Fax: 650-596-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberG71807
License Number StateCA

VIII. Authorized Official

Name: MEGHAN EDDY
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 650-596-8800