| Elite Digestive Specialists | |
|
500 N Valley Pkwy Suite 111 Lewisville TX 75067-3479 | |
| (214) 888-0670 | |
| (972) 221-3917 |
| Full Name | Elite Digestive Specialists |
|---|---|
| Speciality | Internal Medicine |
| Location | 500 N Valley Pkwy, Lewisville, Texas |
| Authorized Official Name and Position | Laxmi Deepika Koya (DIRECTOR) |
| Authorized Official Contact | 2148880670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Digestive Specialists Po Box 293717 Lewisville TX 75029-3762 Ph: (214) 888-0670 | Elite Digestive Specialists 500 N Valley Pkwy Suite 111 Lewisville TX 75067-3479 Ph: (214) 888-0670 |
| NPI Number | 1629521851 |
|---|---|
| Provider Enumeration Date | 07/23/2016 |
| Last Update Date | 10/04/2016 |
| Medicare PECOS PAC ID | 4082909031 |
|---|---|
| Medicare Enrollment ID | O20160830000791 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629521851 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | P0746 (Texas) | Secondary |
| 207RG0100X | Internal Medicine - Gastroenterology | P0746 (Texas) | Primary |
| Provider Name | Laxmi Deepika Koya |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1205883832 PECOS PAC ID: 7618927948 Enrollment ID: I20120703000333 |
| Provider Name | Kushum Pokharel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104328673 PECOS PAC ID: 2860736600 Enrollment ID: I20181204003624 |
| Provider Name | Ancy Varughese Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952877409 PECOS PAC ID: 2466869037 Enrollment ID: I20210326000074 |
| Provider Name | Courtenay Traverse |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508458720 PECOS PAC ID: 1052705316 Enrollment ID: I20220302001580 |
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