=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518296623
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIGESTIVE HEALTH & WELLNESS LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2009
-----------------------------------------------------
Last Update Date | 12/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 OHLTOWN RD AUSTINTOWN MEDICAL PARK, SUITE 204
-----------------------------------------------------
City | AUSTINTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44515-2331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-856-6493
-----------------------------------------------------
Fax | 330-469-2750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 SANDPIPER TRL SE
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44484-5715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-856-6493
-----------------------------------------------------
Fax | 330-469-2750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LEE CLARK LANEY JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 330-856-6493
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 35048805
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------