Provider Demographics
NPI:1528015534
Name:GASTROINTESTINAL HEALTHCARE PA
Entity Type:Organization
Organization Name:GASTROINTESTINAL HEALTHCARE PA
Other - Org Name:DIGESTIVE DISEASES DIAGNOSTIC CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-881-0795
Mailing Address - Street 1:2011 FALLS VALLEY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3451
Mailing Address - Country:US
Mailing Address - Phone:919-881-0743
Mailing Address - Fax:919-881-0822
Practice Address - Street 1:2011 FALLS VALLEY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3451
Practice Address - Country:US
Practice Address - Phone:919-881-0743
Practice Address - Fax:919-881-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0202POtherBLUE CROSS BLUE SHIELD
NC790202PMedicaid
NCDD2963OtherRAILROAD MEDICARE
NC0202POtherBLUE CROSS BLUE SHIELD