Healthcare Provider Details

I. General information

NPI: 1710149802
Provider Name (Legal Business Name): DIGESTIVE HEALTH SPECIALISTS PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17700 SE 272ND ST 420
KENT WA
98042-4951
US

IV. Provider business mailing address

PO BOX 1241
TACOMA WA
98401-1241
US

V. Phone/Fax

Practice location:
  • Phone: 253-639-9660
  • Fax: 253-372-7072
Mailing address:
  • Phone: 253-272-8148
  • Fax: 253-404-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberMTS-2274
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number50D0712074
License Number StateWA

VIII. Authorized Official

Name: NICHOLAS GORALSKY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 253-383-8342