Provider Demographics
NPI:1730219338
Name:COLON AND DIGESTIVE CARE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:COLON AND DIGESTIVE CARE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-814-3182
Mailing Address - Street 1:2301 RIVER RD
Mailing Address - Street 2:300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2093
Mailing Address - Country:US
Mailing Address - Phone:502-814-3182
Mailing Address - Fax:502-814-3196
Practice Address - Street 1:2301 RIVER RD
Practice Address - Street 2:300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2093
Practice Address - Country:US
Practice Address - Phone:502-814-3182
Practice Address - Fax:502-814-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00266Medicare PIN