Provider Demographics
NPI:1760464036
Name:DIGESTIVE DISEASE ENDOSCOPY CENTER, INC.
Entity type:Organization
Organization Name:DIGESTIVE DISEASE ENDOSCOPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:STAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-953-4509
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:615-340-4629
Mailing Address - Fax:615-340-4628
Practice Address - Street 1:222 22ND AVE N
Practice Address - Street 2:SUITE 300
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1852
Practice Address - Country:US
Practice Address - Phone:615-340-4629
Practice Address - Fax:615-340-4628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000006261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3287240Medicaid
TN3287240Medicare PIN