Provider Demographics
NPI:1356358055
Name:PALM SPRINGS DIGESTIVE DISEASE
Entity type:Organization
Organization Name:PALM SPRINGS DIGESTIVE DISEASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:CONGRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-778-6153
Mailing Address - Street 1:555 E TACHEVAH DR
Mailing Address - Street 2:SUITE 1E204
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5750
Mailing Address - Country:US
Mailing Address - Phone:760-778-6153
Mailing Address - Fax:760-778-6785
Practice Address - Street 1:555 E TACHEVAH DR
Practice Address - Street 2:SUITE 1E204
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5750
Practice Address - Country:US
Practice Address - Phone:760-778-6153
Practice Address - Fax:760-778-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC042254207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty