Provider Demographics
NPI:1851385827
Name:DIGESTIVE & LIVER CENTER, PA
Entity Type:Organization
Organization Name:DIGESTIVE & LIVER CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-292-0033
Mailing Address - Street 1:109 PARKING WAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5228
Mailing Address - Country:US
Mailing Address - Phone:979-292-0033
Mailing Address - Fax:979-292-0488
Practice Address - Street 1:109 PARKING WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5228
Practice Address - Country:US
Practice Address - Phone:979-292-0033
Practice Address - Fax:979-292-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5833174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143731101Medicaid
TX00992NMedicare PIN