Provider Demographics
NPI:1164580080
Name:DIGESTIVE DISEASE CENTER, PC
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:VANKINENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-536-9031
Mailing Address - Street 1:420 LOWELL DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3763
Mailing Address - Country:US
Mailing Address - Phone:256-536-9031
Mailing Address - Fax:256-539-4240
Practice Address - Street 1:420 LOWELL DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3763
Practice Address - Country:US
Practice Address - Phone:256-536-9031
Practice Address - Fax:256-539-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1700958873OtherP. VANKINENI'S NPI #
AL1366534307OtherSURESH KARNE'S NPI #
AL529910050Medicaid
ALE324Medicare PIN
AL1700958873OtherP. VANKINENI'S NPI #
ALG71466Medicare UPIN