Provider Demographics
NPI:1841295201
Name:DIGESTIVE DISEASE INSTITUTE INC.
Entity type:Organization
Organization Name:DIGESTIVE DISEASE INSTITUTE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:717-763-0430
Mailing Address - Street 1:899 POPLAR CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2206
Mailing Address - Country:US
Mailing Address - Phone:717-763-0430
Mailing Address - Fax:717-763-9854
Practice Address - Street 1:899 POPLAR CHURCH RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2206
Practice Address - Country:US
Practice Address - Phone:717-763-0430
Practice Address - Fax:717-763-9854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10001500261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012737280001Medicaid
PA391035Medicare ID - Type UnspecifiedMEDICARE NUMBER