Provider Demographics
NPI:1790361608
Name:DFW DIGESTIVE
Entity Type:Organization
Organization Name:DFW DIGESTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, RN
Authorized Official - Phone:214-450-9926
Mailing Address - Street 1:PO BOX 798026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75379-8026
Mailing Address - Country:US
Mailing Address - Phone:214-390-7697
Mailing Address - Fax:972-432-6692
Practice Address - Street 1:470 E STATE HIGHWAY 114
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4406
Practice Address - Country:US
Practice Address - Phone:214-450-9926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center