Organization
GASTROENTEROLOGY SPECIALISTS INC
Active
Other names
Endoscopy Center
Organization subpart
No
Provider details
NPI number
Authorized official
ANA M THEISEN (PRACTICE ADMINISTRATOR)
(330) 455-5011
Entity
Organization
Contact information
Practice address
2726 FULTON DR NW, CANTON, OH 44718-3506
(330) 455-5011
(330) 588-7127
Mailing address
2726 FULTON DR NW, CANTAN, OH 44718-3506
(330) 455-5011
(330) 588-7127
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
0725AS
OH
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000157479
ANTHEM BCBS
OH
05
—
0842333
—
OH
01
—
8467319
AETNA
OH
01
—
P00132061
MEDICARE RAILROAD
OH
Enumeration date
11/09/2005
Last updated
01/14/2021
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