MEDICARE: DIGESTIVE SPECIALISTS OF NORTH HARRIS COUNTY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1053567222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGESTIVE SPECIALISTS OF NORTH HARRIS COUNTY PA

Provider Business Mailing Address
First Line	:	PO BOX 130894
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77393-0894
Country	:	US
Telephone Number	:	936-321-0033
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 IH 45 S STE 2
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340-5649
Country	:	US
Telephone Number	:	888-336-3307
Fax Number	:

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	LIZ WILCOX
Credential	:
Telephone Number	:	936-321-0033

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	08/07/2008

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