Provider Demographics
NPI:1720489370
Name:ANNISTON DIGESTIVE HEALTH PC
Entity Type:Organization
Organization Name:ANNISTON DIGESTIVE HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELOUBEIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-237-1001
Mailing Address - Street 1:901 LEIGHTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5700
Mailing Address - Country:US
Mailing Address - Phone:256-237-1001
Mailing Address - Fax:256-237-0016
Practice Address - Street 1:901 LEIGHTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5700
Practice Address - Country:US
Practice Address - Phone:256-237-1001
Practice Address - Fax:256-237-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23315207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL165429Medicaid
AL511-53806OtherBLUE CROSS BLUE SHIELD
102G705999Medicare PIN