Provider Demographics
NPI:1386763738
Name:DIGESTIVE SPECIALTY CARE INC
Entity type:Organization
Organization Name:DIGESTIVE SPECIALTY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAYEZ
Authorized Official - Middle Name:D
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-440-9292
Mailing Address - Street 1:3130 N COUNTY ROAD 25A
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-1337
Mailing Address - Country:US
Mailing Address - Phone:937-440-9292
Mailing Address - Fax:
Practice Address - Street 1:450 N HYATT ST
Practice Address - Street 2:SUITE 302
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-1433
Practice Address - Country:US
Practice Address - Phone:937-440-9292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGESTIVE SPECIALTY CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-28
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2037638Medicaid
OHDI9281162Medicare ID - Type UnspecifiedMEDICARE