Provider Demographics
NPI:1598958928
Name:DIGESTIVE DISEASE CENTER
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-562-9530
Mailing Address - Street 1:2136 E DESERT INN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-0802
Mailing Address - Country:US
Mailing Address - Phone:702-562-9530
Mailing Address - Fax:702-562-3849
Practice Address - Street 1:2136 E DESERT INN RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-0802
Practice Address - Country:US
Practice Address - Phone:702-562-9530
Practice Address - Fax:702-562-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCH1004OtherRAILROAD MEDICARE
NVV9C0001018Medicare PIN