MEDICARE: TEXAS DIGESTIVE DISEASE CENTER, LTD

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	008164	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7073707	OTHER	TX	AETNA PIN
2	2510957	OTHER	TX	UNITED HEALTHCARE PIN
3	1713599	OTHER	TX	CIGNA PIN

General Provider Information

NPI Number	:	1508871211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS DIGESTIVE DISEASE CENTER, LTD

Provider Business Mailing Address
First Line	:	701 TUSCAN
Second Line	:	# 100
City	:	IRVING
State	:	TX
Zip	:	75039-3834
Country	:	US
Telephone Number	:	214-442-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 TUSCAN
Second Line	:	# 100
City	:	IRVING
State	:	TX
Zip	:	75039-3834
Country	:	US
Telephone Number	:	214-442-1900
Fax Number	:

Authorized Official
Title or Position	:	MANAGER, TDDC MGMT LLC
Name	:	DR. STEVEN M KATZMAN
Credential	:	MD
Telephone Number	:	214-442-1900

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	07/16/2007

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