Healthcare Provider Details
I. General information
NPI: 1861224735
Provider Name (Legal Business Name): INSPIRE CENTER FOR DIGESTIVE HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/19/2024
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
300 CHESTNUT ST STE 500
NEEDHAM MA
02492-2428
US
IV. Provider business mailing address
21 ORCHARD
LAKE FOREST CA
92630-8300
US
V. Phone/Fax
- Phone: 800-403-4234
- Fax:
- Phone: 803-403-4234
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2080P0206X |
| Taxonomy | Pediatric Gastroenterology Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0200X |
| Taxonomy | Pediatric Nurse Practitioner |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
JEFFREY
EDMOND
VOGEL
Title or Position: PRACTICE OWNER
Credential: MD
Phone: 800-403-4234