Provider Demographics
NPI:1720197916
Name:DIGESTIVE HEALTH CENTER, P.A.
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH CENTER, P.A.
Other - Org Name:DIGESTIVE HEALTH CENTER INDEPENDENT LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCNAIR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:228-872-6291
Mailing Address - Street 1:3890 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5803
Mailing Address - Country:US
Mailing Address - Phone:228-872-6291
Mailing Address - Fax:228-872-0452
Practice Address - Street 1:90 INDUSTRIAL PARK CIR
Practice Address - Street 2:A
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5800
Practice Address - Country:US
Practice Address - Phone:228-872-6291
Practice Address - Fax:228-872-0452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25D0319945291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015516Medicaid