1710080973 NPI number — DIGESTIVE HEALTH ASSOCIATES, PC

Table of content: (NPI 1710080973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710080973 NPI number — DIGESTIVE HEALTH ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGESTIVE HEALTH ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710080973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2515 DESALES AVE
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37404-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-698-8101
Provider Business Mailing Address Fax Number:
423-698-3450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2515 DESALES AVE
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37404-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-698-8101
Provider Business Practice Location Address Fax Number:
423-698-3450
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
VIJAY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
423-698-8101

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  20740 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1932181245 . This is a "NPI FOR DONALD HETZEL, MD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 103I502664 . This is a "TN MEDICARE SHANNON FAIRES" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1649558081 . This is a "NPI DESTIN GRIFFIN TRUSSELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1316226616 . This is a "NPI SHANNON FAIRES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1538141411 . This is a "NPI FOR JAMES S MANTON MD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1558343434 . This is a "NPI FOR VIJAY PATEL, MD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 103I502665 . This is a "MEDICARE DESTIN GRIFFIN TRUSSELL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3723922 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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