MEDICARE: DIGESTIVE & LIVER CENTER, 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	174400000X	Specialist	J5833	TX

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	:	1851385827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGESTIVE & LIVER CENTER, PA

Provider Business Mailing Address
First Line	:	109 PARKING WAY ST
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5228
Country	:	US
Telephone Number	:	979-292-0033
Fax Number	:	979-292-0488

Provider Business Practice Location Address
First Line	:	109 PARKING WAY ST
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5228
Country	:	US
Telephone Number	:	979-292-0033
Fax Number	:	979-292-0488

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. MOIN MEAH
Credential	:
Telephone Number	:	979-292-0033

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	06/06/2022

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Directions to “DIGESTIVE & LIVER CENTER, PA ” Practice Location

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