Provider Demographics
NPI:1700807781
Name:GASTROENTROLOGY ASSOCIATES OF ALLIANCE INC
Entity Type:Organization
Organization Name:GASTROENTROLOGY ASSOCIATES OF ALLIANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:RARICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-829-0951
Mailing Address - Street 1:1000 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2019
Mailing Address - Country:US
Mailing Address - Phone:330-337-7717
Mailing Address - Fax:330-337-9195
Practice Address - Street 1:1000 W STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2019
Practice Address - Country:US
Practice Address - Phone:330-337-7717
Practice Address - Fax:330-337-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084462207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2514363Medicaid
OHGA9352711Medicare ID - Type Unspecified