Healthcare Provider Details

I. General information

NPI: 1780659011
Provider Name (Legal Business Name): DIGESTIVE HEALTH SPECIALISTS, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 S CEDAR ST STE. #330
TACOMA WA
98405-2318
US

IV. Provider business mailing address

PO BOX 1241
TACOMA WA
98401-1241
US

V. Phone/Fax

Practice location:
  • Phone: 253-272-5127
  • Fax: 253-272-0811
Mailing address:
  • Phone: 253-272-5127
  • 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