Provider Demographics
NPI:1811367006
Name:DIGESTIVE CARE LABORATORY
Entity Type:Organization
Organization Name:DIGESTIVE CARE LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-596-8800
Mailing Address - Street 1:1000 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3939
Mailing Address - Country:US
Mailing Address - Phone:650-596-8800
Mailing Address - Fax:650-596-8802
Practice Address - Street 1:1000 LAUREL ST
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-3939
Practice Address - Country:US
Practice Address - Phone:650-596-8800
Practice Address - Fax:650-596-8802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGESTIVE CARE ASSOCIATES, A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLA00329354291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACM542AMedicare PIN