Provider Demographics
NPI:1689775595
Name:DIGESTIVE HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-829-8855
Mailing Address - Street 1:5250 KIETZKE LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2037
Mailing Address - Country:US
Mailing Address - Phone:775-829-8855
Mailing Address - Fax:775-829-3752
Practice Address - Street 1:655 SIERRA ROSE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2060
Practice Address - Country:US
Practice Address - Phone:775-829-7600
Practice Address - Fax:775-829-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505892Medicaid
NVWCHKWMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NV100505892Medicaid