Provider Demographics
NPI:1033352455
Name:USHC GASTRO SERVICES, LLC
Entity Type:Organization
Organization Name:USHC GASTRO SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:KOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-708-1515
Mailing Address - Street 1:8185 E WASHINGTON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-4574
Mailing Address - Country:US
Mailing Address - Phone:440-708-1555
Mailing Address - Fax:440-708-1515
Practice Address - Street 1:8185 E WASHINGTON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4574
Practice Address - Country:US
Practice Address - Phone:440-708-1555
Practice Address - Fax:440-708-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062965207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0184812Medicaid