Provider Demographics
NPI:1982831269
Name:DIGESTIVE HEALTH SERVICES PLLC
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALAMISURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-325-3666
Mailing Address - Street 1:510 CHERRY ST
Mailing Address - Street 2:STE. 202
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3338
Mailing Address - Country:US
Mailing Address - Phone:304-325-3666
Mailing Address - Fax:304-327-2497
Practice Address - Street 1:510 CHERRY ST
Practice Address - Street 2:STE. 202
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3338
Practice Address - Country:US
Practice Address - Phone:304-325-3666
Practice Address - Fax:304-327-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11940207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVA77239Medicare UPIN