1447231287 NPI number — GASTROENTEROLOGY SPECIALISTS INC

Table of content: (NPI 1447231287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447231287 NPI number — GASTROENTEROLOGY SPECIALISTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGY SPECIALISTS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ENDOSCOPY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447231287
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2726 FULTON DR NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTAN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44718-3506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-455-5011
Provider Business Mailing Address Fax Number:
330-588-7127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2726 FULTON DR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44718-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-455-5011
Provider Business Practice Location Address Fax Number:
330-588-7127
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
THEISEN
Authorized Official First Name:
ANA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
330-455-5011

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  0725AS , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00132061 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0842333 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000157479 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 8467319 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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