Provider Demographics
NPI:1699853812
Name:CENTER OF GI ENDOSCOPY
Entity Type:Organization
Organization Name:CENTER OF GI ENDOSCOPY
Other - Org Name:RIAD S. ALMUDALLAL, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:SZYMANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-498-0972
Mailing Address - Street 1:34501 AURORA RD
Mailing Address - Street 2:SUITE # 306
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3873
Mailing Address - Country:US
Mailing Address - Phone:440-498-0972
Mailing Address - Fax:440-498-0978
Practice Address - Street 1:34501 AURORA RD
Practice Address - Street 2:SUITE # 306
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3873
Practice Address - Country:US
Practice Address - Phone:440-498-0972
Practice Address - Fax:440-498-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0709AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2430828Medicaid
OH3611741Medicare PIN