Provider Demographics
NPI:1588919906
Name:GASTRO INTESTINAL ASSOCIATES, INC
Entity type:Organization
Organization Name:GASTRO INTESTINAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEIDICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-227-8209
Mailing Address - Street 1:2793 SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-1444
Mailing Address - Country:US
Mailing Address - Phone:419-227-8209
Mailing Address - Fax:419-222-6007
Practice Address - Street 1:139 GARAU ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817-1027
Practice Address - Country:US
Practice Address - Phone:419-227-8209
Practice Address - Fax:419-222-6007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GASTRO INTESTINAL ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0361326Medicaid
OH9160622Medicare PIN