Provider Demographics
NPI:1265547186
Name:AKRON GASTROENTEROLOGY ASSOCIATES, INC.
Entity type:Organization
Organization Name:AKRON GASTROENTEROLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:LANG-LOIUDICE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-877-6613
Mailing Address - Street 1:224 W. EXCHANGE ST.
Mailing Address - Street 2:STE. 410
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1718
Mailing Address - Country:US
Mailing Address - Phone:330-344-6728
Mailing Address - Fax:330-529-4309
Practice Address - Street 1:224 W. EXCHANGE ST.
Practice Address - Street 2:STE.. 410
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1718
Practice Address - Country:US
Practice Address - Phone:330-344-6728
Practice Address - Fax:330-529-4309
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AKRON GASTROENTEROLOGY ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002324207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH222269098001OtherMMO
OH0338923Medicaid
OH4008729OtherAETNA
OH222269098001OtherMMO
OHE03562Medicare UPIN
OH0338923Medicaid