MEDICARE: DIGESTIVE DISEASE CENTER

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	261QA1903X	Ambulatory Surgical Clinic/Center	469ASC-8	NV

General Provider Information

NPI Number	:	1073621512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGESTIVE DISEASE CENTER

Provider Business Mailing Address
First Line	:	2657 WINDMILL PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-3384
Country	:	US
Telephone Number	:	702-734-0505
Fax Number	:	702-734-3912

Provider Business Practice Location Address
First Line	:	2136 E DESERT INN RD STE B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3247
Country	:	US
Telephone Number	:	702-734-0505
Fax Number	:	702-734-3912

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	CYNTHIA J REYES
Credential	:
Telephone Number	:	702-760-7292

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	10/08/2025

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