Provider Demographics
NPI:1699539023
Name:DIGESTIVE CARE P A
Entity type:Organization
Organization Name:DIGESTIVE CARE P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:ABDUS
Authorized Official - Last Name:SAMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-663-2727
Mailing Address - Street 1:151 E ASPEN LN
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-8903
Mailing Address - Country:US
Mailing Address - Phone:501-663-2727
Mailing Address - Fax:501-663-2747
Practice Address - Street 1:1600 W C PL
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2705
Practice Address - Country:US
Practice Address - Phone:870-534-5533
Practice Address - Fax:870-534-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty