1861224735 NPI number — INSPIRE CENTER FOR DIGESTIVE HEALTH PC

Table of content: (NPI 1861224735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861224735 NPI number — INSPIRE CENTER FOR DIGESTIVE HEALTH PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSPIRE CENTER FOR DIGESTIVE HEALTH 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:
1861224735
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 ORCHARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE FOREST
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92630-8300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-403-4234
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CHESTNUT ST STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02492-2428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-403-4234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2024

Additional Information

Authorized Official

Authorized Official Last Name:
VOGEL
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
EDMOND
Authorized Official Title or Position:
PRACTICE OWNER
Authorized Official Telephone Number:
800-403-4234

Provider Taxonomy Codes

  • Taxonomy code: 2080P0206X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 261179 . This is a "BOARD OF REGISTRATION OF MEDICINE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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