Healthcare Provider Details

I. General information

NPI: 1578518247
Provider Name (Legal Business Name): DIGESTIVE HEALTH CENTER OF INDIANA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 WAYNE AVE SUITE 304
INDIANA PA
15701-3501
US

IV. Provider business mailing address

1265 WAYNE AVE SUITE 304
INDIANA PA
15701-3501
US

V. Phone/Fax

Practice location:
  • Phone: 724-465-6384
  • Fax: 724-465-6364
Mailing address:
  • Phone: 724-465-6384
  • Fax: 724-465-6364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number1882
License Number StatePA

VIII. Authorized Official

Name: LYNNE M ADAMS
Title or Position: BUSINESS MANAGER/ADMINISTRATOR
Credential: CMA
Phone: 724-465-6384