Basic Information
| Provider Information | |||||||||
| NPI: | 1306818000 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGESTIVE SPECIALISTS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 BRUBAKER DR | ||||||||
| Address2: | #1 | ||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372932169 | ||||||||
| FaxNumber: | 9372972203 | ||||||||
| Practice Location | |||||||||
| Address1: | 1244 MEADOW BRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372932169 | ||||||||
| FaxNumber: | 9372972203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GANDHI | ||||||||
| AuthorizedOfficialFirstName: | RAMESH | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9372932169 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 2248544 | 05 | OH | MEDICAID |