| Digestive Specialists, Pa | |
|
111 Vision Park Blvd Suite 150 Shenandoah TX 77384-3002 | |
| (936) 321-0033 | |
| (936) 321-0032 |
| Full Name | Digestive Specialists, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 111 Vision Park Blvd, Shenandoah, Texas |
| Authorized Official Name and Position | Liz Wilcox (BILLING SUPERVISOR) |
| Authorized Official Contact | 9363210033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Digestive Specialists, Pa Po Box 130894 The Woodlands TX 77393-0894 Ph: (936) 321-0033 | Digestive Specialists, Pa 111 Vision Park Blvd Suite 150 Shenandoah TX 77384-3002 Ph: (936) 321-0033 |
| NPI Number | 1962402420 |
|---|---|
| Provider Enumeration Date | 07/27/2005 |
| Last Update Date | 07/10/2008 |
| Medicare PECOS PAC ID | 7517934375 |
|---|---|
| Medicare Enrollment ID | O20040913000517 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962402420 | NPI | - | NPPES |
| 0057EB | Other | TX | BLUE CROSS |
| CI6786 | Other | TX | RAIL ROAD MEDICARE |
| 158215701 | Medicaid | TX | |
| 158069801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (Texas) | Primary |
| Provider Name | Mario Cervantes Vazquez |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1245234616 PECOS PAC ID: 5799716403 Enrollment ID: I20050823000353 |
| Provider Name | Edward Xavier |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1154539757 PECOS PAC ID: 8628124153 Enrollment ID: I20090924000056 |
| Provider Name | Lynn R Copeland |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1588665335 PECOS PAC ID: 9739156597 Enrollment ID: I20100825000349 |
| Provider Name | Abraham Winkelstein |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1548260920 PECOS PAC ID: 3274537758 Enrollment ID: I20100825000409 |
| Provider Name | Anna M Gonzales |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1063412351 PECOS PAC ID: 2466456942 Enrollment ID: I20100825000441 |
| Provider Name | Ali T Dural |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1376543470 PECOS PAC ID: 2264492750 Enrollment ID: I20100825000462 |
| Provider Name | Vanitha Bala |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1386662351 PECOS PAC ID: 6608819917 Enrollment ID: I20141111000208 |
| Provider Name | Jamie Respondek Doan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184065021 PECOS PAC ID: 1456645761 Enrollment ID: I20160810000134 |
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