Basic Information
| Provider Information | |||||||||
| NPI: | 1518034354 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH COAST ENDOSCOPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 EXETER RD STE 380 | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381383945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017374665 | ||||||||
| FaxNumber: | 9013281355 | ||||||||
| Practice Location | |||||||||
| Address1: | 9500 MENTOR AVE | ||||||||
| Address2: | SUITE 380 | ||||||||
| City: | MENTOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403529400 | ||||||||
| FaxNumber: | 4403529407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | ASCHA | ||||||||
| AuthorizedOfficialFirstName: | AHMAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4403529400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0800X | 143 FACILITY# 0084AS | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy |
ID Information
| ID | Type | State | Issuer | Description | 0901500 | 05 | OH | MEDICAID | 104697 | 01 | KAISER | OTHER | 18966 | 01 | QUALCHOICE | OTHER | 314359 | 01 | UPMC | OTHER | 6800024 | 01 | UNITED HEALTHCARE | OTHER | 490002140 | 01 | RAILROAD MEDICARE | OTHER | 000000157346 | 01 | ANTHEM | OTHER |