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General NPI Number Information
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NPI Number | 1649720772
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Entity Type | Organization
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Legal Business Name | POMERENE GASTROENTEROLOGY
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 1261 WOOSTER RD STE 210
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City | MILLERSBURG
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State | OH
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Zip | 44654
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Country | US
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Telephone | 330-763-2018
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Fax | 330-763-2063
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Provider Business Mailing Address
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Address Line | 981 WOOSTER RD ATTN: MELISSA FIELITZ
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City | MILLERSBURG
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State | OH
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Zip | 44654-1536
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Country | US
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Telephone | 330-674-1584
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Fax | 330-674-9314
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Authorized Official
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Title or Position | CFO
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Name | JASON JUSTUS
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Credential |
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Telephone | 330-674-1584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | OH
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