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General NPI Number Information
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NPI Number | 1528084431
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Entity Type | Organization
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Legal Business Name | CG ENDOSCOPY CENTER LTD
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 3722 DRESSLER RD NW
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City | CANTON
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State | OH
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Zip | 44718
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Country | US
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Telephone | 330-479-4232
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Fax | 330-477-5805
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Provider Business Mailing Address
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Address Line | 3722 DRESSLER RD NW
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City | CANTON
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State | OH
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Zip | 44718
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Country | US
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Telephone | 330-479-4232
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Fax | 330-477-5805
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | EDWARD T SCHIRACK
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Credential | DO
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Telephone | 330-479-4232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | 0665AS
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License Number State | OH
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