1699853812 NPI number — CENTER OF GI ENDOSCOPY

Table of content: (NPI 1699853812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699853812 NPI number — CENTER OF GI ENDOSCOPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER OF GI ENDOSCOPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RIAD S. ALMUDALLAL, M.D.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699853812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34501 AURORA RD
Provider Second Line Business Mailing Address:
SUITE # 306
Provider Business Mailing Address City Name:
SOLON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44139-3873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-498-0972
Provider Business Mailing Address Fax Number:
440-498-0978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34501 AURORA RD
Provider Second Line Business Practice Location Address:
SUITE # 306
Provider Business Practice Location Address City Name:
SOLON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44139-3873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-498-0972
Provider Business Practice Location Address Fax Number:
440-498-0978
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SZYMANSKI
Authorized Official First Name:
DEVON
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
440-498-0972

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0709AS , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2430828 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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