Provider Demographics
NPI:1245296474
Name:ANDREW J. GASE, M.D., INC
Entity type:Organization
Organization Name:ANDREW J. GASE, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-447-4214
Mailing Address - Street 1:27 ST. LAWRENCE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8313
Mailing Address - Country:US
Mailing Address - Phone:419-447-4214
Mailing Address - Fax:
Practice Address - Street 1:27 ST. LAWRENCE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8313
Practice Address - Country:US
Practice Address - Phone:419-447-4214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-053787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0668684Medicaid
OH0914863Medicaid
OHAN9257921Medicare ID - Type UnspecifiedGROUP NUMBER
OH9257921Medicare PIN
OHA17319Medicare UPIN
OH0914863Medicaid