=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982787255
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH COUNTY CENTER FOR DIGESTIVE HEALTH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1002 S OLD DIXIE HWY SUITE 201
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-7202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-744-2200
-----------------------------------------------------
Fax | 561-744-3083
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1002 S OLD DIXIE HWY SUITE 201
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-7202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-744-2200
-----------------------------------------------------
Fax | 561-744-3083
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROGER S KOERNER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 561-744-2200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------