Provider Demographics
NPI:1578518247
Name:DIGESTIVE HEALTH CENTER OF INDIANA, P.C.
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH CENTER OF INDIANA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:724-465-6384
Mailing Address - Street 1:1265 WAYNE AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3501
Mailing Address - Country:US
Mailing Address - Phone:724-465-6384
Mailing Address - Fax:724-465-6364
Practice Address - Street 1:1265 WAYNE AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3501
Practice Address - Country:US
Practice Address - Phone:724-465-6384
Practice Address - Fax:724-465-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1882261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1882OtherSTATE LICENSE
PA1830947OtherBLUE SHIELD
PA0442OtherBLUE CROSS
PA1882OtherSTATE LICENSE