Healthcare Provider Details

I. General information

NPI: 1760464036
Provider Name (Legal Business Name): DIGESTIVE DISEASE ENDOSCOPY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 22ND AVE N 3RD FLOOR
NASHVILLE TN
37203-1852
US

IV. Provider business mailing address

222 22ND AVE N 3RD FLOOR
NASHVILLE TN
37203-1852
US

V. Phone/Fax

Practice location:
  • Phone: 629-255-2154
  • Fax: 629-255-3075
Mailing address:
  • Phone: 629-255-2620
  • Fax: 629-255-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number0000000006
License Number StateTN

VIII. Authorized Official

Name: CRYSTIE R STAUSS
Title or Position: PHYSICIAN SERVICES MANAGER
Credential:
Phone: 629-255-2620