Provider Demographics
NPI:1083668917
Name:OHIO DIGESTIVE CARE LLC
Entity Type:Organization
Organization Name:OHIO DIGESTIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEFKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-523-1111
Mailing Address - Street 1:200 BRADENTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7515
Mailing Address - Country:US
Mailing Address - Phone:614-793-1980
Mailing Address - Fax:614-793-1985
Practice Address - Street 1:495 COOPER RD
Practice Address - Street 2:SUITE 427
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8723
Practice Address - Country:US
Practice Address - Phone:614-523-1111
Practice Address - Fax:614-523-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-8577207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0815836Medicaid
OH0815836Medicaid