Provider Demographics
NPI:1396833034
Name:SOUTHWEST OHIO GASTROENTEROLOGY, INC
Entity Type:Organization
Organization Name:SOUTHWEST OHIO GASTROENTEROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEL MAURO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:513-605-4800
Mailing Address - Street 1:PO BOX 712585
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-0001
Mailing Address - Country:US
Mailing Address - Phone:513-605-4800
Mailing Address - Fax:513-605-4805
Practice Address - Street 1:11111 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2391
Practice Address - Country:US
Practice Address - Phone:513-605-4800
Practice Address - Fax:513-605-4805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0938203Medicaid
OH0938203Medicaid