Healthcare Provider Details

I. General information

NPI: 1396738936
Provider Name (Legal Business Name): WARREN GASTRO ENDOSCOPY CTR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 E MARKET ST
WARREN OH
44483-6613
US

IV. Provider business mailing address

PO BOX 72188
CLEVELAND OH
44192-0002
US

V. Phone/Fax

Practice location:
  • Phone: 330-399-7215
  • Fax: 330-399-2411
Mailing address:
  • Phone: 330-399-7215
  • Fax: 330-399-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number346 0335AS
License Number StateOH

VIII. Authorized Official

Name: DR. ADEL I YOUSSEF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-399-7215