Provider Demographics
NPI:1982641874
Name:DIGESTIVE HEALTH CLINIC OF EL PASO P A
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH CLINIC OF EL PASO P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VENKATESWARA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:KOLLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-433-3924
Mailing Address - Street 1:SUITE 4A 1250 E. CLIFF DR.
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4850
Mailing Address - Country:US
Mailing Address - Phone:915-541-7000
Mailing Address - Fax:915-541-7002
Practice Address - Street 1:SUITE 4A 1250 E. CLIFF DR.
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4850
Practice Address - Country:US
Practice Address - Phone:915-541-7000
Practice Address - Fax:915-541-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ 5805207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119036501Medicaid
TX119036501Medicaid