Basic Information
| Provider Information | |||||||||
| NPI: | 1710149802 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGESTIVE HEALTH SPECIALISTS PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1241 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984011241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532728148 | ||||||||
| FaxNumber: | 2534040506 | ||||||||
| Practice Location | |||||||||
| Address1: | 17700 SE 272ND ST | ||||||||
| Address2: | 420 | ||||||||
| City: | KENT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980424951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536399660 | ||||||||
| FaxNumber: | 2533727072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 05/08/2017 | ||||||||
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| AuthorizedOfficialLastName: | GORALSKY | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2533838342 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | MTS-2274 | WA | N | Laboratories | Clinical Medical Laboratory | 291U00000X | 50D0712074 | WA | N | Laboratories | Clinical Medical Laboratory | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | CD8128 | 01 | WA | RAILROAD MEDICARE # | OTHER | 7841604 | 05 | WA | MEDICAID |