Provider Demographics
NPI:1346427556
Name:DIGESTIVE DISORDERS INC
Entity Type:Organization
Organization Name:DIGESTIVE DISORDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:814-941-7170
Mailing Address - Street 1:2525 9TH AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2014
Mailing Address - Country:US
Mailing Address - Phone:814-941-7170
Mailing Address - Fax:814-941-7427
Practice Address - Street 1:2525 9TH AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2014
Practice Address - Country:US
Practice Address - Phone:814-941-7170
Practice Address - Fax:814-941-7427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015387340004Medicaid
PAF71359Medicare UPIN
PA786137Medicare PIN