Healthcare Provider Details

I. General information

NPI: 1760491385
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF NORTHERN OHIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 INDUSTRIAL PARKWAY NORTH SUITE 120
BRUNSWICK OH
44212-4316
US

IV. Provider business mailing address

1299 INDUSTRIAL PARKWAY NORTH SUITE 120
BRUNSWICK OH
44212-4316
US

V. Phone/Fax

Practice location:
  • Phone: 330-225-6468
  • Fax: 330-225-6534
Mailing address:
  • Phone: 330-225-6468
  • Fax: 330-225-6534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0659AS
License Number StateOH

VIII. Authorized Official

Name: CHRISTOPHER HARTSHORN
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 314-800-2017