Healthcare Provider Details

I. General information

NPI: 1699853812
Provider Name (Legal Business Name): CENTER OF GI ENDOSCOPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34501 AURORA RD SUITE # 306
SOLON OH
44139-3873
US

IV. Provider business mailing address

34501 AURORA RD SUITE # 306
SOLON OH
44139-3873
US

V. Phone/Fax

Practice location:
  • Phone: 440-498-0972
  • Fax: 440-498-0978
Mailing address:
  • Phone: 440-498-0972
  • Fax: 440-498-0978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0709AS
License Number StateOH

VIII. Authorized Official

Name: MRS. DEVON SZYMANSKI
Title or Position: OFFICE MANAGER
Credential:
Phone: 440-498-0972