Basic Information
| Provider Information | |||||||||
| NPI: | 1265416036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGESTIVE HEALTHCARE, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2417 ATRIUM DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276076673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197912040 | ||||||||
| FaxNumber: | 9197912041 | ||||||||
| Practice Location | |||||||||
| Address1: | 2417 ATRIUM DR | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276076673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197912040 | ||||||||
| FaxNumber: | 9197912041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 03/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | RIG | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9197912040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 86049 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 690236J | 05 | NC | MEDICAID | CH2766 | 01 | NC | RAILROAD MEDICARE | OTHER | 0236J | 01 | NC | BLUE CROSS/BLUE SHIELD NC | OTHER | D448 | 01 | NC | PARTNERS | OTHER |