Provider Demographics
NPI:1639178163
Name:GASTROENTEROLOGY ASSOCIATION OF CLEVELAND, INC.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATION OF CLEVELAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDRASSY
Authorized Official - Suffix:
Authorized Official - Credentials:MED,, PA-C
Authorized Official - Phone:216-593-7180
Mailing Address - Street 1:3700 PARK EAST DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4339
Mailing Address - Country:US
Mailing Address - Phone:216-593-7502
Mailing Address - Fax:216-593-7503
Practice Address - Street 1:3700 PARK EAST DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4339
Practice Address - Country:US
Practice Address - Phone:216-593-7502
Practice Address - Fax:216-593-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000163694OtherANTHEM BCBS
OH0552656Medicaid
OHCN0143OtherRAILROAD MEDICARE
OH000000163694OtherANTHEM BCBS
OH9930006Medicare ID - Type UnspecifiedMEDICARE