Provider Demographics
NPI:1891077160
Name:DIGESTIVE DISEASE SPECIALISTS PC
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-508-8428
Mailing Address - Street 1:2570 24TH ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-5394
Mailing Address - Country:US
Mailing Address - Phone:309-779-4800
Mailing Address - Fax:309-779-4805
Practice Address - Street 1:2570 24TH ST
Practice Address - Street 2:SUITE 125
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5394
Practice Address - Country:US
Practice Address - Phone:309-779-4800
Practice Address - Fax:309-779-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363139231Medicare PIN