Provider Demographics
NPI:1104865021
Name:THE CENTER FOR COLON AND DIGESTIVE DISEASE P C
Entity Type:Organization
Organization Name:THE CENTER FOR COLON AND DIGESTIVE DISEASE P C
Other - Org Name:THE COLON AND DIGESTIVE DISEASE CENTER P C
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-533-6488
Mailing Address - Street 1:PO BOX 2324
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35201-2324
Mailing Address - Country:US
Mailing Address - Phone:256-533-7064
Mailing Address - Fax:256-704-0115
Practice Address - Street 1:119 LONGWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-533-6488
Practice Address - Fax:256-533-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4400135Medicaid
ALCL0068OtherRAILROAD MEDICARE
AL529102520Medicaid
ALJ256Medicare PIN
ALD207Medicare PIN