Provider Demographics
NPI:1255484127
Name:DIGESTIVE HEALTH SPECIALISTS
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-677-8922
Mailing Address - Street 1:3744 STATE ROUTE 257
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-3318
Mailing Address - Country:US
Mailing Address - Phone:814-677-8922
Mailing Address - Fax:
Practice Address - Street 1:3744 STATE ROUTE 257
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-3318
Practice Address - Country:US
Practice Address - Phone:814-677-8922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027029E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015429330007Medicaid
PA0015429330007Medicaid
PA0015312410004Medicaid
PAS50496Medicare UPIN
PA0008642440004Medicaid
PA784627Medicare PIN
PAB35169Medicare UPIN
PAG08367Medicare UPIN
PAPA79318Medicare ID - Type UnspecifiedMICHAEL J. PADALINO, MD