Provider Demographics
NPI:1508880121
Name:DIGESTIVE DISEASE CONSULTANTS, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CONSULTANTS, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GINN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-440-0450
Mailing Address - Street 1:1187 E HERNDON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3166
Mailing Address - Country:US
Mailing Address - Phone:559-440-0450
Mailing Address - Fax:559-440-0461
Practice Address - Street 1:1187 E HERNDON AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3166
Practice Address - Country:US
Practice Address - Phone:559-440-0450
Practice Address - Fax:559-440-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CQ2124OtherMEDICARE RAILROAD
CAGR0057880Medicaid
ZZZ38536ZOtherBLUE CROSS
ZZZ38536ZOtherBLUE SHIELD
CQ2124OtherMEDICARE RAILROAD