MEDICARE: GASTRO-INTESTINAL ASSOCIATES 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
1	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1417991563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTRO-INTESTINAL ASSOCIATES INC

Provider Business Mailing Address
First Line	:	2793 SHAWNEE ROAD
Second Line	:	GASTRO-INTESTINAL ASSOCIATES, INC.
City	:	LIMA
State	:	OH
Zip	:	45806
Country	:	US
Telephone Number	:	419-227-8209
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 E 5TH ST
Second Line	:
City	:	DELPHOS
State	:	OH
Zip	:	45833-9139
Country	:	US
Telephone Number	:	419-227-8209
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT L NEIDICH
Credential	:	M.D.
Telephone Number	:	419-227-8209

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	10/10/2008

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