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General NPI Number Information
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NPI Number | 1376522615
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Entity Type | Organization
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Legal Business Name | DIGESTIVE HEALTH ASSOCIATES PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 2 BURNETT CT STE 100
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City | DURANGO
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State | CO
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Zip | 81301-3647
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Country | US
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Telephone | 970-385-4022
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Fax | 970-385-4337
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Provider Business Mailing Address
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Address Line | 2 BURNETT CT STE 100
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City | DURANGO
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State | CO
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Zip | 81301-3647
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Country | US
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Telephone | 970-385-4022
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Fax | 970-385-4337
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | CASSANDRA PEACOCK
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Credential |
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Telephone | 970-385-4022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | B65222
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License Number State | CO
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