Healthcare Provider Details

I. General information

NPI: 1821364332
Provider Name (Legal Business Name): DIGESTIVE HEALTH SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 FALLS AVE E STE 1151
TWIN FALLS ID
83301-3455
US

IV. Provider business mailing address

1411 FALLS AVE E STE 1151
TWIN FALLS ID
83301-3455
US

V. Phone/Fax

Practice location:
  • Phone: 208-933-4277
  • Fax: 208-933-4280
Mailing address:
  • Phone: 208-933-4277
  • Fax: 208-933-4280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberM6676
License Number StateID

VIII. Authorized Official

Name: TED REA
Title or Position: OWNER
Credential: M.D.
Phone: 208-280-7541