MEDICARE: GASTROENTEROLOGY ASSOCIATION OF CLEVELAND, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician		OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CN0143	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000163694	OTHER	OH	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639178163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROENTEROLOGY ASSOCIATION OF CLEVELAND, INC.

Provider Business Mailing Address
First Line	:	3700 PARK EAST DR
Second Line	:	SUITE 100
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4339
Country	:	US
Telephone Number	:	216-593-7502
Fax Number	:	216-593-7503

Provider Business Practice Location Address
First Line	:	3700 PARK EAST DR
Second Line	:	SUITE 100
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4339
Country	:	US
Telephone Number	:	216-593-7502
Fax Number	:	216-593-7503

Authorized Official
Title or Position	:	CEO/ADMINISTRATOR
Name	:	MR. JAMES J ANDRASSY
Credential	:	M.ED,, PA-C
Telephone Number	:	216-593-7180

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/21/2022

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Directions to “GASTROENTEROLOGY ASSOCIATION OF CLEVELAND, INC. ” Practice Location

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