Provider Demographics
NPI:1144325614
Name:DIGESTIVE HEALTHCARE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:DIGESTIVE HEALTHCARE ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-464-9507
Mailing Address - Street 1:2206 ROOSEVELT RD
Mailing Address - Street 2:STE A
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2749
Mailing Address - Country:US
Mailing Address - Phone:219-464-9507
Mailing Address - Fax:219-477-4690
Practice Address - Street 1:2206 ROOSEVELT RD
Practice Address - Street 2:STE A
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2749
Practice Address - Country:US
Practice Address - Phone:219-464-9507
Practice Address - Fax:219-477-4690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN658650Medicare ID - Type Unspecified