Provider Demographics
NPI:1205865409
Name:GASTROENTEROLOGY OF CANTON ENDOSCOPY CENTER INC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY OF CANTON ENDOSCOPY CENTER INC
Other - Org Name:GOC ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-492-6662
Mailing Address - Street 1:4124 MUNSON ST NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2979
Mailing Address - Country:US
Mailing Address - Phone:330-492-6662
Mailing Address - Fax:330-492-6918
Practice Address - Street 1:4124 MUNSON ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2979
Practice Address - Country:US
Practice Address - Phone:330-492-6662
Practice Address - Fax:330-492-6918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0382AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH651202OtherAETNA
OH2038262Medicaid
OH000000357184OtherANTHEM
OH651202OtherAETNA
OH=========002OtherMEDICAL MUTUAL
OH=========026OtherCARESOURCE
OH=========026OtherCARESOURCE