Healthcare Provider Details

I. General information

NPI: 1538495759
Provider Name (Legal Business Name): DIGESTIVE SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 10/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 COTTONVILLE RD
JAMESTOWN OH
45335-1522
US

IV. Provider business mailing address

999 BRUBAKER DR
KETTERING OH
45429-3588
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-4424
  • Fax: 937-395-3682
Mailing address:
  • Phone: 937-293-4424
  • Fax: 937-395-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA K SMITH
Title or Position: CREDENTIALING SPECIALISTS
Credential:
Phone: 937-293-4424