Provider Demographics
NPI:1497086607
Name:REGIONAL DIGESTIVE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:REGIONAL DIGESTIVE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-875-3033
Mailing Address - Street 1:4511 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5336
Mailing Address - Country:US
Mailing Address - Phone:228-769-7791
Mailing Address - Fax:228-769-7747
Practice Address - Street 1:1721 MEDICAL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2109
Practice Address - Country:US
Practice Address - Phone:228-392-1686
Practice Address - Fax:228-392-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06023748Medicaid