Provider Demographics
NPI:1679706790
Name:DIGESTIVE DISEASE CENTER-GREEN VALLEY
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CENTER-GREEN VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:HAIKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-734-0505
Mailing Address - Street 1:1647 WINDMILL LANE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123
Mailing Address - Country:US
Mailing Address - Phone:702-628-5830
Mailing Address - Fax:702-270-8984
Practice Address - Street 1:1647 WINDMILL LANE
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123
Practice Address - Country:US
Practice Address - Phone:702-628-5830
Practice Address - Fax:702-270-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2000772.650261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical