Provider Demographics
NPI:1417991563
Name:GASTRO-INTESTINAL ASSOCIATES INC
Entity Type:Organization
Organization Name:GASTRO-INTESTINAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEIDICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-227-8209
Mailing Address - Street 1:2793 SHAWNEE ROAD
Mailing Address - Street 2:GASTRO-INTESTINAL ASSOCIATES, INC.
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806
Mailing Address - Country:US
Mailing Address - Phone:419-227-8209
Mailing Address - Fax:
Practice Address - Street 1:1800 E 5TH ST
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-9139
Practice Address - Country:US
Practice Address - Phone:419-227-8209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GASTRO INTESTINAL ASSOCIATES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9160627Medicare ID - Type Unspecified