Healthcare Provider Details

I. General information

NPI: 1417935503
Provider Name (Legal Business Name): AVAMAR CENTER FOR ENDOSCOPY,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 E MARKET ST
WARREN OH
44484-5517
US

IV. Provider business mailing address

9225 E MARKET ST
WARREN OH
44484-5517
US

V. Phone/Fax

Practice location:
  • Phone: 330-372-7470
  • Fax: 330-372-7480
Mailing address:
  • Phone: 330-372-7470
  • Fax: 330-372-7480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number0624AS
License Number StateOH

VIII. Authorized Official

Name: MRS. BARBARA E. STEINBECK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 330-372-7470