Healthcare Provider Details

I. General information

NPI: 1083094460
Provider Name (Legal Business Name): DIGESTIVE CARE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 NORTHAMPTON ST
EDWARDSVILLE PA
18704-4551
US

IV. Provider business mailing address

14201 DALLAS PKWY
DALLAS TX
75254-2916
US

V. Phone/Fax

Practice location:
  • Phone: 570-288-8100
  • Fax:
Mailing address:
  • Phone: 570-288-8100
  • Fax: 570-714-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIAN RASMUS
Title or Position: VP, CFO
Credential:
Phone: 469-893-2532