Provider Demographics
NPI:1992971329
Name:DIGESTIVE SPECIALISTS OF NORTH HARRIS COUNTY PA
Entity type:Organization
Organization Name:DIGESTIVE SPECIALISTS OF NORTH HARRIS COUNTY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-472-7096
Mailing Address - Street 1:PO BOX 130894
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77393-0894
Mailing Address - Country:US
Mailing Address - Phone:936-321-0033
Mailing Address - Fax:
Practice Address - Street 1:800 PEAKWOOD DR
Practice Address - Street 2:SUITE 7H
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2900
Practice Address - Country:US
Practice Address - Phone:936-321-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0057EBOtherBLUE CROSS
TX158069801Medicaid
TXCI6786OtherRAIL ROAD MEDICARE
TX00386TMedicare PIN