Healthcare Provider Details

I. General information

NPI: 1184687386
Provider Name (Legal Business Name): DIGESTIVECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 09/02/2025
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVANIA DR
BEAVERCREEK OH
45440-3237
US

IV. Provider business mailing address

75 SYLVANIA DR
BEAVERCREEK OH
45440-3237
US

V. Phone/Fax

Practice location:
  • Phone: 937-320-5050
  • Fax: 937-320-5060
Mailing address:
  • Phone: 937-320-5050
  • Fax: 937-320-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number139
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number36D0711013
License Number StateOH

VIII. Authorized Official

Name: CHRISTOPHER HARTSHORN
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 314-800-2017