Provider Demographics
NPI:1245224286
Name:TIPPECANOE ENDOSCOPY INC
Entity Type:Organization
Organization Name:TIPPECANOE ENDOSCOPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YING
Authorized Official - Middle Name:K
Authorized Official - Last Name:AMORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-726-0132
Mailing Address - Street 1:1210 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4003
Mailing Address - Country:US
Mailing Address - Phone:330-726-0132
Mailing Address - Fax:330-726-2571
Practice Address - Street 1:1210 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4003
Practice Address - Country:US
Practice Address - Phone:330-726-0132
Practice Address - Fax:330-726-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0009AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0300481Medicaid
OH0300481Medicaid