=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598854796
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GASTROENTEROLOGY ASSOCIATES OF CLEVELAND, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12200 MCCRACKEN RD SUITE 550
-----------------------------------------------------
City | GARFIELD HTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44125-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-593-7700
-----------------------------------------------------
Fax | 216-593-7503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3700 PARK EAST DR SUITE 100
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-4339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-593-7700
-----------------------------------------------------
Fax | 216-593-7503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/CIO
-----------------------------------------------------
Name | MR. JAMES J ANDRASSY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-593-7180
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------