MEDICARE: DIGESTIVE SPECIALISTS, INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538495759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGESTIVE SPECIALISTS, INC.

Provider Business Mailing Address
First Line	:	999 BRUBAKER DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-3588
Country	:	US
Telephone Number	:	937-293-4424
Fax Number	:	937-395-3682

Provider Business Practice Location Address
First Line	:	4940 COTTONVILLE RD
Second Line	:
City	:	JAMESTOWN
State	:	OH
Zip	:	45335-1522
Country	:	US
Telephone Number	:	937-293-4424
Fax Number	:	937-395-3682

Authorized Official
Title or Position	:	CREDENTIALING SPECIALISTS
Name	:	LINDA K SMITH
Credential	:
Telephone Number	:	937-293-4424

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	10/22/2009

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