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General NPI Number Information
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NPI Number | 1588200554
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Entity Type | Organization
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Legal Business Name | PORTAGE PHYSICIANS ENDOSCOPY INC
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 3973 LOOMIS PKWY
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City | RAVENNA
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State | OH
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Zip | 44266-1803
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Country | US
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Telephone | 330-399-7215
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Fax |
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Provider Business Mailing Address
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Address Line | 1622 E MARKET ST
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City | WARREN
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State | OH
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Zip | 44483-6613
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Country | US
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Telephone | 330-399-7215
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Fax | 330-399-2411
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ADEL YOUSSEF
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Credential | MD
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Telephone | 330-399-7215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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