Provider Demographics
NPI:1073621512
Name:DIGESTIVE DISEASE CENTER
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:O
Authorized Official - Last Name:HAIKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-734-0505
Mailing Address - Street 1:2136 E DESERT INN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-3247
Mailing Address - Country:US
Mailing Address - Phone:702-734-0505
Mailing Address - Fax:702-734-3912
Practice Address - Street 1:2136 E DESERT INN RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-3247
Practice Address - Country:US
Practice Address - Phone:702-734-0505
Practice Address - Fax:702-734-3912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV469ASC-8261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV004602010Medicaid
NV49002208OtherRAILROAD MEDICARE
NVV9C0001018Medicare PIN