Provider Demographics
NPI:1376650028
Name:GASTROENTEROLOGY ASSOC OF SE OHIO, INC.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOC OF SE OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SZEMETYLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-454-8193
Mailing Address - Street 1:999 GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1330
Mailing Address - Country:US
Mailing Address - Phone:740-454-8193
Mailing Address - Fax:740-454-1470
Practice Address - Street 1:999 GARDEN RD
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1330
Practice Address - Country:US
Practice Address - Phone:740-454-8193
Practice Address - Fax:740-454-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0962365Medicaid
OH9264531Medicare PIN
OH0962365Medicaid