Provider Demographics
NPI:1932276276
Name:CANTON GENERAL SURGERY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CANTON GENERAL SURGERY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMARATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-453-4300
Mailing Address - Street 1:2600 TUSCARAWAS ST WEST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-453-4300
Mailing Address - Fax:330-453-3617
Practice Address - Street 1:2600 TUSCARAWAS ST W
Practice Address - Street 2:SUITE 420
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4644
Practice Address - Country:US
Practice Address - Phone:330-453-4300
Practice Address - Fax:330-453-3617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0298628Medicaid
OH2345966Medicaid
OH0668648Medicaid
OHH70819Medicare UPIN
OH0668648Medicaid
OH2345966Medicaid
OHE92260Medicare UPIN
OH0298628Medicaid
OHKE4083741Medicare ID - Type Unspecified
OHC01727Medicare UPIN