Healthcare Provider Details

I. General information

NPI: 1588919906
Provider Name (Legal Business Name): GASTRO INTESTINAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 GARAU ST
BLUFFTON OH
45817-1027
US

IV. Provider business mailing address

2793 SHAWNEE RD
LIMA OH
45806-1444
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-8209
  • Fax: 419-222-6007
Mailing address:
  • Phone: 419-227-8209
  • Fax: 419-222-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT L NEIDICH
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 419-227-8209