Provider Demographics
NPI:1154637122
Name:DIGESTIVE HEALTHCARE OF CENTRAL TENNESSEE, PLLC
Entity Type:Organization
Organization Name:DIGESTIVE HEALTHCARE OF CENTRAL TENNESSEE, PLLC
Other - Org Name:DIGESTIVE HEALTHCARE OF MIDDLE TENNESSEE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:931-735-6036
Mailing Address - Street 1:112 AIRPORT BUSINESS PARK DRIVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160
Mailing Address - Country:US
Mailing Address - Phone:931-735-6036
Mailing Address - Fax:931-735-6293
Practice Address - Street 1:112 AIRPORT BUSINESS PARK DRIVE
Practice Address - Street 2:SUITE G
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160
Practice Address - Country:US
Practice Address - Phone:931-735-6036
Practice Address - Fax:931-735-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2139207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G29356Medicare UPIN