=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265416036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIGESTIVE HEALTHCARE, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2005
-----------------------------------------------------
Last Update Date | 03/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2417 ATRIUM DR SUITE 150
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-6673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-791-2040
-----------------------------------------------------
Fax | 919-791-2041
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2417 ATRIUM DR SUITE 150
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-6673
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-791-2040
-----------------------------------------------------
Fax | 919-791-2041
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RIG S. PATEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 919-791-2040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 86049
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------