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General NPI Number Information
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NPI Number | 1164580080
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Entity Type | Organization
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Legal Business Name | DIGESTIVE DISEASE CENTER, PC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 420 LOWELL DRIVE SUITE 204
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3763
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Country | US
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Telephone | 256-536-9031
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Fax | 256-539-4240
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Provider Business Mailing Address
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Address Line | 420 LOWELL DRIVE SUITE 204
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3763
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Country | US
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Telephone | 256-536-9031
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Fax | 256-539-4240
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Authorized Official
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Title or Position | PRESIDENT
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Name | PRASAD S VANKINENI
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Credential | M.D.
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Telephone | 256-536-9031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | AL
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