Provider Demographics
NPI:1053754986
Name:DIGESTIVE HEALTH CENTER OF THE FOUR STATES, LLC
Entity type:Organization
Organization Name:DIGESTIVE HEALTH CENTER OF THE FOUR STATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MD
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-783-1650
Mailing Address - Street 1:198 FOUR STATES DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GALENA
Mailing Address - State:KS
Mailing Address - Zip Code:66739-4304
Mailing Address - Country:US
Mailing Address - Phone:620-783-1650
Mailing Address - Fax:620-783-1652
Practice Address - Street 1:198 FOUR STATES DR
Practice Address - Street 2:SUITE 6
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4304
Practice Address - Country:US
Practice Address - Phone:620-783-1650
Practice Address - Fax:620-783-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty