Provider Demographics
NPI:1376522615
Name:DIGESTIVE HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEACOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-385-4022
Mailing Address - Street 1:1305 ESCALANTE DR SUITE 204
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-8932
Mailing Address - Country:US
Mailing Address - Phone:970-385-4022
Mailing Address - Fax:970-385-4337
Practice Address - Street 1:1305 ESCALANTE DR SUITE 204
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-8932
Practice Address - Country:US
Practice Address - Phone:970-385-4022
Practice Address - Fax:970-385-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COB65222174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01268457Medicaid
CO9000150560Medicaid
COGED3028OtherBLUE CROSS BLUE SHIELD
CO100007417OtherRAILROAD MEDICARE