Provider Demographics
NPI:1790868099
Name:ASSOCIATES IN DIGESTIVE HEALTH LLC
Entity Type:Organization
Organization Name:ASSOCIATES IN DIGESTIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BREYLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:239-772-3636
Mailing Address - Street 1:625 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2667
Mailing Address - Country:US
Mailing Address - Phone:239-772-3636
Mailing Address - Fax:239-772-5073
Practice Address - Street 1:625 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2667
Practice Address - Country:US
Practice Address - Phone:239-772-3636
Practice Address - Fax:239-772-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7519547OtherAETNA
FL269648700Medicaid
FL45406OtherBCBS
FL7519547OtherAETNA
FLDB3677Medicare ID - Type UnspecifiedRAILROAD MEDICARE