Provider Demographics
NPI:1528045002
Name:DIGESTIVE DISEASE CONSULTANTS PA
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCINTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-830-8661
Mailing Address - Street 1:623 MAITLAND AVE
Mailing Address - Street 2:STE 2200
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701
Mailing Address - Country:US
Mailing Address - Phone:407-830-8661
Mailing Address - Fax:407-830-0280
Practice Address - Street 1:623 MAITLAND AVE
Practice Address - Street 2:STE 2200
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:407-830-8661
Practice Address - Fax:407-830-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377661100Medicaid
FL38470Medicare ID - Type Unspecified