Provider Demographics
NPI:1053818344
Name:TEXAS DIGESTIVE DISEASE CONSULTANTS PLLC
Entity Type:Organization
Organization Name:TEXAS DIGESTIVE DISEASE CONSULTANTS PLLC
Other - Org Name:GI ALLIANCE PHARMACY- DFW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MISKIMINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-572-0009
Mailing Address - Street 1:1620 W NORTHWEST HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3119
Mailing Address - Country:US
Mailing Address - Phone:817-572-0009
Mailing Address - Fax:817-945-3778
Practice Address - Street 1:6317 HARRIS PKWY STE 320
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4256
Practice Address - Country:US
Practice Address - Phone:682-707-3760
Practice Address - Fax:817-720-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
TX319403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176985OtherPK