Healthcare Provider Details

I. General information

NPI: 1487924536
Provider Name (Legal Business Name): MILL CREEK ENDOSCOPY SUITES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 BOARDMAN CANFIELD RD
YOUNGSTOWN OH
44512-4003
US

IV. Provider business mailing address

1622 E MARKET ST
WARREN OH
44483-6613
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-0132
  • Fax: 330-726-2571
Mailing address:
  • Phone: 330-399-7215
  • Fax: 330-399-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number2068615
License Number StateOH

VIII. Authorized Official

Name: MS. DENISE IRWIN
Title or Position: BILLING ADMINISTRATOR
Credential:
Phone: 330-399-7215