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General NPI Number Information
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NPI Number | 1215100961
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Entity Type | Organization
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Legal Business Name | DIGESTIVE HEALTH PROFESSIONALS LLC
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 02/20/2012
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Provider Practice Location Address
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Address Line | 2216 E 32ND ST SUITE 201
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City | JOPLIN
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State | MO
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Zip | 64804-3016
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Country | US
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Telephone | 417-781-7110
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Fax | 417-621-0445
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Provider Business Mailing Address
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Address Line | PO BOX 4889
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City | JOPLIN
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State | MO
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Zip | 64803-4889
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Country | US
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Telephone | 417-781-7110
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Fax | 417-621-0445
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LISA J LEBEDA
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Credential |
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Telephone | 417-781-7110
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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 | MO
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