Provider Demographics
NPI:1871248740
Name:GU OHIO, LLC
Entity Type:Organization
Organization Name:GU OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-213-7129
Mailing Address - Street 1:5710 TWIN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7849
Mailing Address - Country:US
Mailing Address - Phone:740-213-7129
Mailing Address - Fax:440-201-6574
Practice Address - Street 1:1225 WOODLAWN AVE STE 114
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3094
Practice Address - Country:US
Practice Address - Phone:740-213-7129
Practice Address - Fax:440-201-6574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1619257508OtherNPI