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NPI Code Detail

MEDICARE: WARREN GASTRO ENDOSCOPY CTR INC

MEDICARE: WARREN GASTRO ENDOSCOPY CTR INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center346 0335ASOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000157529OTHEROHANTHEM PIN

General Provider Information

NPI Number : 1396738936
Entity Type Code : Organization
Provider Name (Legal Business Name) : WARREN GASTRO ENDOSCOPY CTR INC
Provider Business Mailing Address
First Line : PO BOX 72188
Second Line :
City : CLEVELAND
State : OH
Zip : 44192-0002
Country : US
Telephone Number : 330-399-7215
Fax Number : 330-399-2411
Provider Business Practice Location Address
First Line : 1622 E MARKET ST
Second Line :
City : WARREN
State : OH
Zip : 44483-6613
Country : US
Telephone Number : 330-399-7215
Fax Number : 330-399-2411
Authorized Official
Title or Position : PRESIDENT
Name : DR. ADEL I YOUSSEF
Credential : M.D.
Telephone Number : 330-399-7215
Provider Enumeration Date : 08/30/2005
Last Update Date : 05/06/2021

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Directions to “WARREN GASTRO ENDOSCOPY CTR INC ” Practice Location

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