Provider Demographics
NPI:1629030358
Name:DIGESTIVE CARE P A
Entity type:Organization
Organization Name:DIGESTIVE CARE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:STUCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-534-5533
Mailing Address - Street 1:PO BOX 2797
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-2797
Mailing Address - Country:US
Mailing Address - Phone:870-534-5533
Mailing Address - Fax:870-534-5535
Practice Address - Street 1:4800 S HAZEL ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6860
Practice Address - Country:US
Practice Address - Phone:870-534-5533
Practice Address - Fax:870-534-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12162000000OtherQUAL CHOICE
AR5B793OtherBLUE CROSS BLUE SHIELD
ARDG3779OtherRAILROAD MEDICARE
4600296OtherAETNA
2920027OtherUNITED HEALTHCARE
AR129049002Medicaid
12162000000OtherQUAL CHOICE