Provider Demographics
NPI:1215100961
Name:DIGESTIVE HEALTH PROFESSIONALS LLC
Entity type:Organization
Organization Name:DIGESTIVE HEALTH PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEBEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-781-7110
Mailing Address - Street 1:PO BOX 4889
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-4889
Mailing Address - Country:US
Mailing Address - Phone:417-781-7110
Mailing Address - Fax:417-621-0445
Practice Address - Street 1:2216 E 32ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3016
Practice Address - Country:US
Practice Address - Phone:417-781-7110
Practice Address - Fax:417-621-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty