| Digestive Disease Center, Pc | |
|
420 Lowell Drive Suite 204 Huntsville AL 35801-3763 | |
| (256) 536-9031 | |
| (256) 539-4240 |
| Full Name | Digestive Disease Center, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 420 Lowell Drive, Huntsville, Alabama |
| Authorized Official Name and Position | Prasad S Vankineni (PRESIDENT) |
| Authorized Official Contact | 2565369031 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Digestive Disease Center, Pc 420 Lowell Drive Suite 204 Huntsville AL 35801-3763 Ph: (256) 536-9031 | Digestive Disease Center, Pc 420 Lowell Drive Suite 204 Huntsville AL 35801-3763 Ph: (256) 536-9031 |
| NPI Number | 1164580080 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 08/12/2013 |
| Medicare PECOS PAC ID | 3476584228 |
|---|---|
| Medicare Enrollment ID | O20050822001239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164580080 | NPI | - | NPPES |
| 1700958873 | Other | AL | P. VANKINENI'S NPI # |
| 1366534307 | Other | AL | SURESH KARNE'S NPI # |
| 529910050 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (Alabama) | Primary |
| Provider Name | Melanie Sue Sisulak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679699847 PECOS PAC ID: 1658563937 Enrollment ID: I20101005000536 |
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