Healthcare Provider Details

I. General information

NPI: 1376751891
Provider Name (Legal Business Name): DIGESTIVE CARE OF EVANSVILLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 11/18/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 VENETIAN WAY STE 200
NEWBURGH IN
47630-8257
US

IV. Provider business mailing address

3800 VENETIAN WAY
NEWBURGH IN
47630-8257
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-6103
  • Fax:
Mailing address:
  • Phone: 812-477-6103
  • Fax: 812-477-4897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HUGH W. MOORS
Title or Position: ADMINISTRATOR
Credential:
Phone: 812-477-6103