Provider Demographics
NPI:1689788838
Name:DIGESTIVE HEALTH SPECIALISTS OF TYLER
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH SPECIALISTS OF TYLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAYER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:903-595-5101
Mailing Address - Street 1:1720 SOUTH BECKHAM
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701
Mailing Address - Country:US
Mailing Address - Phone:903-595-5101
Mailing Address - Fax:903-597-2314
Practice Address - Street 1:1720 SOUTH BECKHAM
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-595-5101
Practice Address - Fax:903-597-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00475UMedicare ID - Type Unspecified