MEDICARE: TEXAS DIGESTIVE DISEASE CONSULTANTS PLLC

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	:	1962215129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS DIGESTIVE DISEASE CONSULTANTS PLLC

Provider Business Mailing Address
First Line	:	950 E STATE HIGHWAY 114 STE 200
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-5261
Country	:	US
Telephone Number	:	214-424-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 HIGHLAND PKWY
Second Line	:
City	:	PICAYUNE
State	:	MS
Zip	:	39466-5574
Country	:	US
Telephone Number	:	985-871-1721
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	KRISTINA KAY LOWERY
Credential	:
Telephone Number	:	317-919-9025

Provider Enumeration Date	:	01/30/2025
Last Update Date	:	04/21/2026

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