Basic Information
| Provider Information | |||||||||
| NPI: | 1558683714 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARIZONA CENTER FOR DIGESTIVE HEALTH, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3799 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852993799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805075678 | ||||||||
| FaxNumber: | 4805075677 | ||||||||
| Practice Location | |||||||||
| Address1: | 3420 S MERCY RD | ||||||||
| Address2: | SUITE 211 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852970419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805075678 | ||||||||
| FaxNumber: | 4805075677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2010 | ||||||||
| LastUpdateDate: | 03/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | SHARMA | ||||||||
| AuthorizedOfficialFirstName: | VIRENDER | ||||||||
| AuthorizedOfficialMiddleName: | KUMAR | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNERPHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4805075678 | ||||||||
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| 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 | 261Q00000X | 29571 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | G36236 | 01 | AZ | UPIN | OTHER |