Provider Demographics
NPI:1083730782
Name:ADVANCED CONCEPTS IN ENDOSCOPY LLC
Entity Type:Organization
Organization Name:ADVANCED CONCEPTS IN ENDOSCOPY LLC
Other - Org Name:ADVANCED CONCEPTS IN ENDOSCOPY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-350-9595
Mailing Address - Street 1:7551 FREDLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:44077
Mailing Address - Country:US
Mailing Address - Phone:440-357-1474
Mailing Address - Fax:440-357-1905
Practice Address - Street 1:7551 FREDLE DRIVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:OH
Practice Address - Zip Code:44077
Practice Address - Country:US
Practice Address - Phone:440-357-1474
Practice Address - Fax:440-357-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003594M207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty