Provider Demographics
NPI:1760491385
Name:ENDOSCOPY CENTER OF NORTHERN OHIO, LLC
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER OF NORTHERN OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTSHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-800-2017
Mailing Address - Street 1:1299 INDUSTRIAL PARKWAY NORTH
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4316
Mailing Address - Country:US
Mailing Address - Phone:330-225-6468
Mailing Address - Fax:330-225-6534
Practice Address - Street 1:1299 INDUSTRIAL PARKWAY NORTH
Practice Address - Street 2:SUITE 120
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-4316
Practice Address - Country:US
Practice Address - Phone:330-225-6468
Practice Address - Fax:330-225-6534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0659AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2307408Medicaid
OH3611602Medicare PIN