Provider Demographics
NPI:1821364332
Name:DIGESTIVE HEALTH SERVICES, LTD
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:REA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-280-7541
Mailing Address - Street 1:1411 FALLS AVE E STE 1151
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3455
Mailing Address - Country:US
Mailing Address - Phone:208-933-4277
Mailing Address - Fax:208-933-4280
Practice Address - Street 1:1411 FALLS AVE E STE 1151
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3455
Practice Address - Country:US
Practice Address - Phone:208-933-4277
Practice Address - Fax:208-933-4280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6676207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty