Provider Demographics
NPI:1417935206
Name:DIGESTIVE DISEASE CENTER, LP
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CENTER, LP
Other - Org Name:MEMORIAL CARE DIGESTIVE CARE CENTER SADDLEBACK MEMORIAL, AN AFFILIATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-586-9386
Mailing Address - Street 1:24411 HEALTH CENTER DR
Mailing Address - Street 2:SUITE 450
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3633
Mailing Address - Country:US
Mailing Address - Phone:949-586-9386
Mailing Address - Fax:949-586-0864
Practice Address - Street 1:24411 HEALTH CENTER DR
Practice Address - Street 2:SUITE 450
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3633
Practice Address - Country:US
Practice Address - Phone:949-586-9386
Practice Address - Fax:949-586-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051134Medicare UPIN