Provider Demographics
NPI:1912946385
Name:ALABAMA DIGESTIVE DISORDERS CENTER, PC
Entity type:Organization
Organization Name:ALABAMA DIGESTIVE DISORDERS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GASTROENTEROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SMITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-882-7888
Mailing Address - Street 1:4601 WHITESBURG DR SE STE 101
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1677
Mailing Address - Country:US
Mailing Address - Phone:256-882-7888
Mailing Address - Fax:256-882-7886
Practice Address - Street 1:4601 WHITESBURG DR SE STE 101
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1677
Practice Address - Country:US
Practice Address - Phone:256-882-7888
Practice Address - Fax:256-882-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529801520Medicaid
AL529801520Medicaid