Provider Demographics
NPI:1578799235
Name:DIGESTIVE DISEASE CARE CENTER, LLC
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QAISER
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-625-8300
Mailing Address - Street 1:300 MEDICAL PLZ
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1481
Mailing Address - Country:US
Mailing Address - Phone:636-625-8300
Mailing Address - Fax:636-625-8301
Practice Address - Street 1:300 MEDICAL PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1481
Practice Address - Country:US
Practice Address - Phone:636-625-8300
Practice Address - Fax:636-625-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004001639207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty