Basic Information
| Provider Information | |||||||||
| NPI: | 1275909780 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAREDO DIGESTIVE HEALTH CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6999 MCPHERSON RD | ||||||||
| Address2: | SUITE 219 | ||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780416449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567280030 | ||||||||
| FaxNumber: | 9567280031 | ||||||||
| Practice Location | |||||||||
| Address1: | 6999 MCPHERSON RD | ||||||||
| Address2: | SUITE 219 | ||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780416449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567280030 | ||||||||
| FaxNumber: | 9567280031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2015 | ||||||||
| LastUpdateDate: | 01/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | HOHLFELD | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 2155899024 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.