Provider Demographics
NPI:1518938240
Name:CLEVELAND GASTROENTEROLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:CLEVELAND GASTROENTEROLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-480-0008
Mailing Address - Street 1:808 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3858
Mailing Address - Country:US
Mailing Address - Phone:704-480-0008
Mailing Address - Fax:704-480-0010
Practice Address - Street 1:808 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3858
Practice Address - Country:US
Practice Address - Phone:704-480-0008
Practice Address - Fax:704-480-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890140GMedicaid
NC230848Medicare ID - Type Unspecified