Provider Demographics
NPI:1952497117
Name:THE GASTROENTEROLOGY CLINIC & ENDOSCOPY CENTER INC
Entity Type:Organization
Organization Name:THE GASTROENTEROLOGY CLINIC & ENDOSCOPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-399-7215
Mailing Address - Street 1:PO BOX 72188
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:330-399-7215
Mailing Address - Fax:330-399-2411
Practice Address - Street 1:1622 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6613
Practice Address - Country:US
Practice Address - Phone:330-399-7215
Practice Address - Fax:330-399-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058015207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0382643Medicaid
OH9287521Medicare PIN