Basic Information
| Provider Information | |||||||||
| NPI: | 1801943949 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTER FOR DIGESTIVE CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3901 66TH ST N | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337094949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273455500 | ||||||||
| FaxNumber: | 7273456164 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 66TH ST N | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337094949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273455500 | ||||||||
| FaxNumber: | 7273456164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 01/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | SREENATH | ||||||||
| AuthorizedOfficialFirstName: | BELUR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7273455500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 38969 | 01 | BCBS FLORIDA | OTHER | CG5974 | 01 | RAILROAD MEDICARE | OTHER | 2292472 | 01 | AETNA | OTHER |