Provider Demographics
NPI:1336799121
Name:DIGESTIVE CARE SPECIALISTS, LLC
Entity type:Organization
Organization Name:DIGESTIVE CARE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-315-7995
Mailing Address - Street 1:PO BOX 51670
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-1670
Mailing Address - Country:US
Mailing Address - Phone:307-315-7995
Mailing Address - Fax:307-333-4425
Practice Address - Street 1:1026 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2902
Practice Address - Country:US
Practice Address - Phone:307-333-0002
Practice Address - Fax:307-333-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1518179126Medicaid