1396803680 NPI number — CENTER FOR DIGESTIVE HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396803680 NPI number — CENTER FOR DIGESTIVE HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR DIGESTIVE HEALTH
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:
1396803680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 LOWELL DRIVE SE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-535-5940
Provider Business Mailing Address Fax Number:
256-535-5954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7738 MADSON BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-430-4427
Provider Business Practice Location Address Fax Number:
256-430-4335
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOHRENWEND
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
256-430-4427

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  16209 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51525690 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051525690 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: K225 . This is a "MEDICARE GROUP PIN" identifier . This identifiers is of the category "OTHER".




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