Provider Demographics
NPI:1518296623
Name:DIGESTIVE HEALTH & WELLNESS LTD
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH & WELLNESS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:LANEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:330-856-6493
Mailing Address - Street 1:120 SANDPIPER TRL SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-5715
Mailing Address - Country:US
Mailing Address - Phone:330-856-6493
Mailing Address - Fax:330-469-2750
Practice Address - Street 1:20 OHLTOWN RD
Practice Address - Street 2:AUSTINTOWN MEDICAL PARK, SUITE 204
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2331
Practice Address - Country:US
Practice Address - Phone:330-856-6493
Practice Address - Fax:330-469-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048805207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA76728Medicare UPIN